Effectiveness of Mavrilimumab in Viral Infections Including SARS-CoV-2 Infection - A Brief Review

Abstract

Hyperinflammation and cytokine storm has been noted as a poor prognostic factor in patients with severe pneumonia related to coronavirus disease 2019 (COVID-19). In COVID-19, pathogenic myeloid cell overactivation is found to be a vital mediator of damage to tissues, hypercoagulability, and the cytokine storm. These cytokines unselectively infiltrate various tissues, such as the lungs and heart, and nervous system. This cytokine storm can hence cause multi-organ dysfunction and life-threatening complications. Mavrilimumab is a monoclonal antibody (mAb) that may be helpful in some cases with COVID-19. During an inflammation, Granulocyte-macrophage colony-stimulating factor (GM-CSF) release is crucial to driving both innate and adaptive immune responses. The GM-CSF immune response is triggered when an antigen attaches to the host cell and induces the signaling pathway. Mavrilimumab antagonizes the action of GM-CSF and decreases the hyperinflammation associated with pneumonia in COVID-19, therefore strengthening the rationale that mavrilimumab when added to the standard protocol of treatment could improve the clinical outcomes in COVID-19 patients, specifically those patients with pneumonia. With this review paper, we aim to demonstrate the inhibitory effect of mavrilimumab on cytokine storms in patients with COVID-19 by reviewing published clinical trials and emphasize the importance of extensive future trials.

Comparative efficacy and safety of pharmacological interventions for severe COVID-19 patients: An updated network meta-analysis of 48 randomized controlled trials

“…This finding was contrary to previous studies which have suggested that some antiviral drugs (hydrocortisone, mavrilimumab, etc) were associated with decreased ACM in patients with COVID-19. [ 29 , 32 , 89 , 90 ] It is difficult to explain this result, but it might be related to the difference of participants’ selection in differential studies. For instance, the findings of this NMA were based on a larger sample size (i.e., more participants were included).…”

“…Correspondingly, most of the previous studies presented a smaller sample size. [ 29 , 32 ] The present study differed from earlier studies, [ 90 , 91 ] which selected subjects with all infection levels (i.e., mild, moderate and severe infections). Furthermore, prior studies were inadequate for the analyses stratified by different infection levels (i.e., non-severe and severe infection) in medications of COVID-19.…”

“…Furthermore, prior studies were inadequate for the analyses stratified by different infection levels (i.e., non-severe and severe infection) in medications of COVID-19. [ 29 , 32 , 89 , 90 ] Prior studies suggested that COVID-19 patients at different infection levels often led to different outcomes of treatment. [ 92 ] Another possible explanation for this was that we compared the efficacy and safety of SOC, which existed the bias due to the differential SOC of every country (i.e., the SOC is not standardized) except for the reasons given above.…”