Interleukin-6 blockade for severe COVID-19

Abstract

In the context of COVID-19 pandemic and growing tensions worldwide regarding healthcare facilities, there is an urgent need for effective treatments likely to reduce the crunch of ICU beds. Following the assumption by Mehta and colleagues who exhorted physicians to screen patients with severe COVID-19 for hyperinflammation and investigate immunomodulatory drugs in this setting, we relate our short-term -yet promising -experience regarding IL6 blockade with tocilizumab in 30 selected patients of less than 80 years of age, >5 days of prior disease duration, severe (i.e. requiring strictly over 6L/min of oxygen therapy) rapidly deteriorating (i.e. increase by more than 3L/min of oxygen flow within the previous 12 hours) COVID-19-related pneumonia. By comparison with a control group of patients (matched for age, gender and disease severity using the inverse probability of treatment weighted methodology) that did not receive . CC-BY-NC-ND 4.0 International license It is made available under a is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. (which was not certified by peer review)

Addition of Tocilizumab to the Standard of Care Reduces Mortality in Severe COVID-19: A Systematic Review and Meta-Analysis

“…Currently, treatment of severe COVID-19 with antiviral therapy such as remdesivir, hydroxychloroquine, lopinavir, ritonavir, or any other antiviral agents along with supportive treatment is considered as the standard of care (SOC). Recently, steroids such methylprednisolone has been included as a standard of treatment ( 17 ).…”

Beneficial effect of corticosteroids in severe COVID-19 pneumonia: a propensity score matching analysis

“…requiring more than 6 liters of oxygen, treated with tocilizumab, with 30 patients matched for age, gender, and disease severity. Treatment with tocillizumab significantly reduced the risk of subsequent ICU admission [25]. Overall, based on these limited results, one could put forth the assumption that the higher the oxygen necessity and the higher the inflammation, the more effective anti-inflammatory drugs could be.…”

“…Multiple antiviral treatment options have been evaluated in vitro, but demonstration of their convincing efficacy in vivo needs yet to be done [14][15][16][17][18][19][20][21][22][23]. Similarly, several anti-inflammatory drugs, especially corticosteroids and tocilizumab, are candidates to treat patients with COVID-19 pneumonia [9,12,13,[24][25][26][27][28].…”

“…This type of treatment may be useful in case of administration after viral clearance, during the inflammatory phase of the disease, in order to dissipate the "cytokine storm" that can occur following the viral trigger in the setting of aberrant immune-inflammatory response [9,[24][25][26][27]. Overall, studies to validate new therapeutic options are urgently needed.…”

A modular framework for the development of targeted Covid-19 blood transcript profiling panels

“…Targets of interest identified among our gene set include: 1) IL6R in A35/S2 (inflammation), encoding the Interleukin-6 Receptor, which is a target for the biologic drug Tocilizumab. Several studies have tested this antagonist in open label single arm trials in Covid-19 patients with the intent of blocking the cytokine storm associated with severe Covid-19 infection (17,18).…”