Multimodality treatment in immunocompromised patients with severe <scp>COVID</scp>‐19: the role of <scp>IL</scp>‐6 inhibitor, intravenous immunoglobulin, and haemoperfusion

Leelayuwatanakul, Nophol; Kongpolprom, Napplika; Sriprasart, Thitiwat; Phoophiboon, Vorakamol; Thanthitaweewat, Vorawut; Thawanaphong, Sarita; Sirichana, Worawan; Chirakalwasan, Naricha; Kawkitinarong, Kamon; Sittipunt, Chanchai; Putcharoen, Opass; Paitoonpong, Leilani; Suwanpimolkul, Gompol; Jantarabenjakul, Watsamon; Srisawat, Nattachai; Pachinburavan, Monvasi

doi:10.1002/rcr2.733

Cited by 2 publications

(2 citation statements)

References 41 publications

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“…Following the elimination of duplicates and screening of titles and abstracts, we evaluated 244 articles in full text. Among these, we found 43 eligible articles (5 RCTs, 16 cohort studies, 2 case-control studies, and 20 case reports) (Figure 1) (Salvarani et al, 2021;REMAP-CAP Investigators et al, 2021;Canziani et al, 2020;Menzella et al, 2020;Fisher et al, 2021;Campochiaro et al, 2020;Vazquez Guillamet et al, 2021;Rajendram et al, 2021;Huang et al, 2021;Galván-Román et al, 2021;Saffo et al, 2021;Somers et al, 2021;Brosnahan et al, 2021;Corominas et al, 2021;Cavalli et al, 2021;Abe et al, 2021;Patel et al, 2020;Mady et al, 2020;Bernardo et al, 2020;Morillas et al, 2020;Cascella et al, 2020;Al-Kaf et al, 2021;Eroglu et al, 2021;Kataoka et al, 2021;Kishaba et al, 2021;Leelayuwatanakul et al, 2021;McKenzie et al, 2021;Nourié et al, 2021;Ladna et al, 2021;Senegaglia et al, 2021;Thammathiwat et al, 2021;Lescure et al, 2021;Della-Torre et al, 2020;Gremese et al, 2020;Kyriazopoulou et al, 2021a;Bozzi et al, 2021;Franzetti et al, 2021;…”

Section: Search Resultsmentioning

confidence: 99%

Specific Interleukin-1 Inhibitors, Specific Interleukin-6 Inhibitors, and GM-CSF Blockades for COVID-19 (at the Edge of Sepsis): A Systematic Review

et al. 2022

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Sepsis is a syndrome with high mortality, which seriously threatens human health. During the pandemic of coronavirus disease 2019 (COVID-19), some severe and critically ill COVID-19 patients with multiple organ dysfunction developed characteristics typical of sepsis and met the diagnostic criteria for sepsis. Timely detection of cytokine storm and appropriate regulation of inflammatory response may be significant in the prevention and treatment of sepsis. This study evaluated the efficacy and safety of specific interleukin (IL)-1 inhibitors, specific IL-6 inhibitors, and GM-CSF blockades in the treatment of COVID-19 (at the edge of sepsis) patients through systematic review and meta-analysis. Methodology: A literature search was conducted on PubMed, EMBASE, Clinical Key, Cochrane Library, CNKI, and Wanfang Database using proper keywords such as “SARS-CoV-2,” “Corona Virus Disease 2019,” “COVID-19,” “anakinra,” “tocilizumab,” “siltuximab,” “sarilumab,” “mavrilimumab,” “lenzilumab,” and related words for publications released until August 22, 2021. Other available resources were also used to identify relevant articles. The present systematic review was performed based on PRISMA protocol. Results: Based on the inclusion and exclusion criteria, 43 articles were included in the final review. The meta-analysis results showed that tocilizumab could reduce the mortality of patients with COVID-19 (at the edge of sepsis) [randomized controlled trials, RCTs: odds ratio (OR) 0.71, 95%CI: 0.52–0.97, low-certainty evidence; non-RCTs: risk ratio (RR) 0.68, 95%CI: 0.55–0.84, very low-certainty evidence) as was anakinra (non-RCTs: RR 0.47, 95%CI: 0.34–0.66, very low-certainty evidence). Sarilumab might reduce the mortality of patients with COVID-19 (at the edge of sepsis), but there was no statistical significance (OR 0.65, 95%CI: 0.36–1.2, low-certainty evidence). For safety outcomes, whether tocilizumab had an impact on serious adverse events (SAEs) was very uncertain (RCTs: OR 0.87, 95%CI: 0.38–2.0, low-certainty evidence; non-RCTs 1.18, 95%CI: 0.83–1.68, very low-certainty evidence) as was on secondary infections (RCTs: OR 0.71, 95%CI: 0.06–8.75, low-certainty evidence; non-RCTs: RR 1.15, 95%CI: 0.89–1.49, very low-certainty evidence). Conclusions: This systematic review showed that tocilizumab, sarilumab, and anakinra could reduce the mortality of people with COVID-19 (at the edge of sepsis), and tocilizumab did not significantly affect SAEs and secondary infections. The current evidence of the studies on patients treated with siltuximab, mavrilimumab, and lenzilumab is insufficient. In order to establish evidence with stronger quality, high-quality studies are needed.Systematic Review Registration: PROSPERO (https://www.crd.york.ac.uk/prospero/), identifier CRD42020226545

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Section: Search Resultsmentioning

confidence: 99%

Specific Interleukin-1 Inhibitors, Specific Interleukin-6 Inhibitors, and GM-CSF Blockades for COVID-19 (at the Edge of Sepsis): A Systematic Review

et al. 2022

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“…Although a clinical trial (NCT04370834) studying the efficacy of Tocilizumab in cancer patients with COVID-19 was terminated, a recent case report using Tocilizumab, corticosteroids, and IV immunoglobulin in immunocompromised patients with severe COVID-19 requiring mechanical ventilation demonstrated improved hemodynamic stability and were discharged without adverse events [109].…”

Section: Convalescent Plasmamentioning

confidence: 99%

Cancer and COVID-19: unravelling the immunological interplay with a review of promising therapies against severe SARS-CoV-2 for cancer patients

et al. 2023

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Cancer patients, due to their immunocompromised status, are at an increased risk for severe SARS-CoV-2 infection. Since severe SARS-CoV-2 infection causes multiple organ damage through IL-6-mediated inflammation while stimulating hypoxia, and malignancy promotes hypoxia-induced cellular metabolic alterations leading to cell death, we propose a mechanistic interplay between both conditions that results in an upregulation of IL-6 secretion resulting in enhanced cytokine production and systemic injury. Hypoxia mediated by both conditions results in cell necrosis, dysregulation of oxidative phosphorylation, and mitochondrial dysfunction. This produces free radicals and cytokines that result in systemic inflammatory injury. Hypoxia also catalyzes the breakdown of COX-1 and 2 resulting in bronchoconstriction and pulmonary edema, which further exacerbates tissue hypoxia. Given this disease model, therapeutic options are currently being studied against severe SARS-COV-2. In this study, we review several promising therapies against severe disease supported by clinical trial evidence—including Allocetra, monoclonal antibodies (Tixagevimab–Cilgavimab), peginterferon lambda, Baricitinib, Remdesivir, Sarilumab, Tocilizumab, Anakinra, Bevacizumab, exosomes, and mesenchymal stem cells. Due to the virus’s rapid adaptive evolution and diverse symptomatic manifestation, the use of combination therapies offers a promising approach to decrease systemic injury. By investing in such targeted interventions, cases of severe SARS-CoV-2 should decrease along with its associated long-term sequelae and thereby allow cancer patients to resume their treatments.

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Multimodality treatment in immunocompromised patients with severe COVID‐19: the role of IL‐6 inhibitor, intravenous immunoglobulin, and haemoperfusion

Cited by 2 publications

References 41 publications

Specific Interleukin-1 Inhibitors, Specific Interleukin-6 Inhibitors, and GM-CSF Blockades for COVID-19 (at the Edge of Sepsis): A Systematic Review

Specific Interleukin-1 Inhibitors, Specific Interleukin-6 Inhibitors, and GM-CSF Blockades for COVID-19 (at the Edge of Sepsis): A Systematic Review

Cancer and COVID-19: unravelling the immunological interplay with a review of promising therapies against severe SARS-CoV-2 for cancer patients

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