Antirheumatic agents in covid-19: is IL-6 the right target?

Abstract

Contributors PLC: conception and design of the work, acquisition, analysis or interpretation of data, drafting the work, final approval of the version published, agreement to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved. PEL: substantial contribution to the conception or design of the work and revising the manuscript critically for important intellectual content, final approval of the version published. LV, MAM: substantial contribution to the part of the work involving X-ray and revising the manuscript critically for important intellectual content, final approval of the version published. BR, GZ: substantial contribution to the part of the work involving virus infection and revising the manuscript critically for important intellectual content, final approval of the version published. DB, EB: substantial contribution to the part of the work involving lung injury and revising the manuscript critically for important intellectual content, final approval of the version published. FF: substantial contribution to the part of the work involving intensive care and revising the manuscript critically for important intellectual content, final approval of the version published. MC, SV: substantial contribution to the part of the work involving heart damage and revising the manuscript critically for important intellectual content, final approval of the version published. LC: substantial contribution to the part of the work involving antirheumatic agents and revising the manuscript critically for important intellectual content, final approval of the version published. BF: substantial contribution to the conception of the work and to the part of the work involving antirheumatic agents and revising the manuscript critically for important intellectual content, final approval of the version published. The authors agree to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.

Portable Pocket-Sized Ultrasound Scanner for the Evaluation of Lung Involvement in Coronavirus Disease 2019 Patients

“…Current therapeutic strategy involves agents counteracting viral invasion and replication, and inhibitors of cytokine-sustained inflammatory reactions. No specific antiviral therapy has yet been identified ( Capecchi et al 2020 , Conticini et al 2020 ).…”

SARS-CoV-2 in pleural fluid in a kidney transplant patient

“…Cytokine release syndrome is a systemic inflammatory response, that can be triggered by infection, certain drugs, and other factors. It has been demonstrated in COVID-19 patients [ 9 ]. In vitro experiments show that delayed release of cytokines and chemokines occurs in respiratory epithelial cells, dendritic cells, and macrophages in the early stage of SARS-CoV-2 infection, and that the cells secrete low levels of interferon antiviral factors and high levels of proinflammatory cytokines (interleukins IL-1β, IL-6, and tumor necrosis factor) and chemokines [ 10 ].…”

“…No specific antiviral therapy for SARS-CoV-2 infection has yet been found, although most reports suggest that immunomodulation therapy can play a positive role. Blockade of IL-6 and IL-1 has shown promising results and high doses of steroids prove to reduce mortality, moderating cytokine release [ 9 , 11 ].…”

“…In solid organ transplant recipients, such as our patient, the risk of pneumonia and development of ARDS is expected to be higher, although a number of reports have indicated a similar incidence to that of the general population [ 14 , 15 ]. The hypothesis that post-transplant immunosuppression can somehow protect patients against the hyperinflammatory syndrome resulting from the cytokine storm induced by SARS‐CoV‐2 is intriguing and needs further confirmation [ 9 , 16 ]. In the present case, despite the setbacks our patient had to face (severe kidney failure and intestinal perforation requiring dialysis and surgery, respectively), the outcome was positive and the patient was eventually discharged.…”

Correspondence on ‘Interleukin-6 receptor blockade with subcutaneous tocilizumab in severe COVID-19 pneumonia and hyperinflammation: case–control study’

“…Among them, corticosteroids, IL-6 or IL-1 antagonists have been reported and successfully used in severe COVID-19 and associated hyperinflammatory syndromes. [1][2][3][4] The hyperinflammation observed in adult patients with severe COVID-19 resembles a cytokine release syndrome (CRS) associated with CD4 + and CD8 + T-cell lymphopaenia and increased cytokine levels, including IL-6, correlating with clinical severity. [5][6][7][8][9] In contrast to CRS, immune reconstitution inflammatory syndrome (IRIS) is an exaggerated inflammatory response driven by predominant CD4 + T helper cells that have been reported secondary to previous initiation of antiretroviral therapy (ART) when the immune system begins to recover following treatment with ART.…”