Can we use interleukin-6 (IL-6) blockade for coronavirus disease 2019 (COVID-19)-induced cytokine release syndrome (CRS)?

Liu, Bingwen; Li, Min; Zhou, Zhiguang; Guan, Xuan; Xiang, Yufei

doi:10.1016/j.jaut.2020.102452

Cited by 653 publications

(688 citation statements)

References 98 publications

Supporting

Mentioning

637

Contrasting

Unclassified

Order By: Relevance

“…The NLR, the ratio of neutrophils to lymphocytes, is considered an important marker of the systemic in ammatory response, and more accurately re ects the balanced relationship between the severity of in ammatory reactions and the immune state (23,24). It is believed that the in ammatory cytokine storm may be related to the progression of the disease (25)(26)(27)(28). We speculate that there may be a signi cant correlation between the NLR and severe COVID-19.…”

Section: Discussionmentioning

confidence: 93%

An increased pretreatment neutrophil-to-lymphocyte ratio predicts severe novel coronavirus-infected pneumonia

Wang

Jiang

Huang

et al. 2020

Preprint

View full text Add to dashboard Cite

Objective The aim of this study was to identify early warning signs for severe novel coronavirus-infected pneumonia (COVID-19).Methods We retrospectively analyzed the clinical data of 90 patients with COVID-19 at the Guanggu District of Hubei Women and Children Medical and Healthcare Center comprising 60 mild cases and 30 severe cases. The demographic data, underlying diseases, clinical manifestations and laboratory blood test results were compared between the two groups. Logistic regression analysis was performed to identify the independent risk factors that predicted severe COVID-19. The receiver-operating characteristic (ROC) curve of independent risk factors was calculated, and the area under the curve (AUC) was used to evaluate the efficiency of the prediction of severe COVID-19.Results The patients with mild and severe COVID-19 showed significant differences in terms of cancer incidence, age, pretreatment neutrophil-to-lymphocyte ratio (NLR), C-reactive protein (CRP) and the serum albumin (ALB) level (P<0.05). The severity of COVID-19 was correlated positively with the comorbidity of cancer, age, NLR, and CRP but was negatively correlated with the ALB level (P<0.05). Multivariate logistic regression analysis showed that the NLR and ALB level were independent risk factors for severe COVID-19 (OR=1.319, 95% CI: 1.043-1.669, P=0.021; OR=0.739, 95% CI: 0.616-0.886, P=0.001), with AUCs of 0.851 and 0.128, respectively. An NLR of 4.939 corresponded to the maximum joint sensitivity and specificity according to the ROC curve (0.700 and 0.917, respectively).Conclusion An increased NLR can serve as an early warning sign of severe COVID-19.

show abstract

Section: Discussionmentioning

confidence: 93%

An increased pretreatment neutrophil-to-lymphocyte ratio predicts severe novel coronavirus-infected pneumonia

Wang

Jiang

Huang

et al. 2020

Preprint

View full text Add to dashboard Cite

show abstract

“…High levels of IL-6 were observed in patients with COVID-19 and might serve as a predictive biomarker for disease severity [5,30,31]. Mechanistically, IL-6 acts as a critical cytokine in the systemic in ammatory response [32], leading to a myriad of biological effects that contribute to pulmonary in ltration and organ damage [33,34]. In a recent trial, tocilizumab [35], a recombinant humanized anti-human IL-6 receptor antibody, improved clinical symptoms by attenuating in ammation in COVID-19.…”

Section: Discussionmentioning

confidence: 98%

High-dose vitamin C infusion for the treatment of critically ill COVID-19

Rao

Zhu

et al. 2020

Preprint

View full text Add to dashboard Cite

BackgroundNo specific medication has been proven effective for the treatment of patients with severe coronavirus disease 2019 (COVID-19). Here, we tested whether high-dose vitamin C infusion was effective for severe COVID-19.MethodsThis randomized, controlled clinical trial was performed at 3 hospitals in Hubei, China. Patients with confirmed severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection in the ICU were randomly assigned in as 1:1 ratio to either the high-dose intravenous vitamin C (HDIVC) or the placebo. HDIVC group received 12 g of vitamin C/50 ml every 12 hours for 7 days at a rate of 12 ml/hour, and the placebo group received bacteriostatic water for injection in the same way. The primary outcome was invasive mechanical ventilation-free days in 28 days(IMVFD28). Secondary outcomes were 28-day mortality, organ failure, and inflammation progression.ResultsFifty-four critical COVID-19 patients were ultimately recruited. There was no difference in IMVFD28 between two groups. During the 7-day treatment period, patients in the HDIVC group had a steady rise in the PaO2/FiO2 (day 7: 229 vs. 151 mmHg, 95% CI 33 to 122, P = 0.01). Patients with SOFA scores ≥ 3 in the HDIVC group exhibited a significant reduction in 28-day mortality (P = 0.05) in univariate survival analysis. IL-6 in the VC group was lower than that in the placebo group (19.42 vs. 158.00; 95% CI -301.72 to -29.79; P = 0.04) on day 7.ConclusionThe addition of HDIVC may provide a protective clinical effect without any adverse events in critically ill patients with COVID-19.Clinicaltrial.gov identifer: NCT04264533

show abstract

“…91,92 In these cases, the treatment goal is to prevent or attenuate life-threatening inflammation while minimizing the potential for secondary infection. 93 For this reason, immunomodulatory treatments should be used cautiously. The use of prophylactic antibiotics may be indicated, and bacteriologic and fungal assessments are of great importance.…”

Section: Comorbiditymentioning

confidence: 99%

Immunomodulatory Therapeutic Proteins in COVID‐19: Current Clinical Development and Clinical Pharmacology Considerations

Chen

Golding

et al. 2020

The Journal of Clinical Pharma

View full text Add to dashboard Cite

The coronavirus disease 2019 (COVID‐19) pandemic caused by infection with SARS‐CoV‐2 has led to more than 600 000 deaths worldwide. Patients with severe disease often experience acute respiratory distress characterized by upregulation of multiple cytokines. Immunomodulatory biological therapies are being evaluated in clinical trials for the management of the systemic inflammatory response and pulmonary complications in patients with advanced stages of COVID‐19. In this review, we summarize the clinical pharmacology considerations in the development of immunomodulatory therapeutic proteins for mitigating the heightened inflammatory response identified in COVID‐19.

show abstract

Can we use interleukin-6 (IL-6) blockade for coronavirus disease 2019 (COVID-19)-induced cytokine release syndrome (CRS)?

Cited by 653 publications

References 98 publications

An increased pretreatment neutrophil-to-lymphocyte ratio predicts severe novel coronavirus-infected pneumonia

An increased pretreatment neutrophil-to-lymphocyte ratio predicts severe novel coronavirus-infected pneumonia

High-dose vitamin C infusion for the treatment of critically ill COVID-19

Immunomodulatory Therapeutic Proteins in COVID‐19: Current Clinical Development and Clinical Pharmacology Considerations

Contact Info

Product

Resources

About