Patients improve after immunosuppressive treatment

According to an observational study at Cedars-Sinai, most patients hospitalized with COVID-19 (coronavirus) pneumonia experienced improvement after receiving a US Food and Drug Administration-approved drug, which is usually given for rheumatoid arthritis. .. Outcomes of patients treated with the drug tocilizumab include reduced inflammation, oxygen requirements, blood pressure support, and risk of death compared to reports of illness and death associated with severe COVID-19 patients. included.

Single center, Observational study Of the 27 patients, on June 23, led by Dr. Stanley Jordan, head of the Cedars-Sinai Nephrology and Transplant Immunology Program. Clinical infection..

Patient outcomes were promising, but researchers are insufficient to demonstrate the safety and efficacy of the drug in COVID-19 patients because they did not conduct clinical trials with controls I said.

The team targeted 27 patients with COVID-19 pneumonia who received the immunosuppressive drug tocilizumab to delay an uncontrolled immune response, including oxygen levels, blood pressure, and the need for medication to increase patient survival. , Investigated laboratory and clinical changes. The researchers observed improved inflammatory markers and patient survival compared to reports of patients not treated with tocilizumab.

“The researchers have been studying tocilizumab for 10 years, focusing on its use in cytokine storms associated with rheumatoid arthritis and cancer,” said Jordan, professor of medicine at Cedars-Sinai. The drug was approved by the FDA in 2010 as a treatment for Rheumatoid arthritis..

Researchers at Cedars-Sinai have discovered that interleukin 6, a protein that stimulates immune cell production and is the target of tocilizumab, is a major cytokine elevated in COVID-19 patients.

“We infer that tocilizumab blocks interleukin-6, so it makes sense to try it in patients with COVID-19 pneumonia,” Jordan explained.

Cytokines are molecules secreted by multiple cell types, including cells of the immune system that regulate the body’s immune response. A cytokine storm is a serious reaction in which immune cells are flooded and attack healthy organs that should protect them. In COVID-19 patients, the virus stimulates immune cells, causing collateral lung injury. This can leak blood vessels and cause blood to clot. The patient’s blood pressure drops and the organs fail.

Early in the COVID-19 pandemic, health professionals discovered that a cytokine storm was causing rapid deterioration in some patients. The key to the survival of patients the researchers are learning is to prevent the storm from gaining power.

Most patients who received tocilizumab were on a ventilator to support their breathing. Each of them received one dose of tocilizumab. This helps block the signaling of the cytokine interleukin-6. It is the only cytokine detected in harmful amounts in all study patients.

“The more interleukin 6 you have in your body, the worse your patient’s outcome will be,” said Jordan.

Post-treatment results showed that 23 patients experienced a significant reduction in body temperature and C-reactive protein (CRP) levels. The presence of an infection in the body raises CRP levels. No sharp decline in CRP levels was seen in 4 patients and poor outcome in 3 patients. Although the adverse events were minimal, Jordan said two deaths unrelated to tocilizumab occurred.

“Our observational study suggests that drug therapy may help reduce the risk of inflammation, oxygen requirements, blood pressure support, and death,” said Jordan.

Jordan’s current work builds on his previous work with tocilizumab. The study focused on the potential of drugs to block the deleterious effects of interleukin-6 on organ transplants, including rejection of donor organs. In this study, tocilizumab Immune reaction Prevents organ rejection. Jordan and his colleagues are currently conducting a randomized, placebo-controlled trial of another interleukin 6 blocker, the investigational drug Clazakizumab.

Jordan is encouraged on the potential benefits of tocilizumab for patients with COVID-19 pneumonia, based on past and current studies.

“Based on our preliminary results, we hope this class of drugs will help improve patients with COVID-19 pneumonia,” said Jordan. “But until the randomized controlled clinical trials are completed, the results are unknown.”