Window of Opportunity for Immunodulatory Therapy in COVID-19

Authors

  • Raquel Faria Unidade de Imunologia Clínica, Centro Hospitalar e Universitário do Porto, Porto, Portugal; UMIB – Unit for Multidisciplinary Research in Biomedicine, Porto, Portugal https://orcid.org/0000-0002-2956-1966
  • Graziela Carvalheiras Unidade de Imunologia Clínica, Centro Hospitalar e Universitário do Porto, Porto, Portugal; Serviço de Cuidados Intensivos – Unidade de Cuidados Intermédios Médico-Cirúrgica, Centro Hospitalar e Universitário do Porto, Porto, Portugal https://orcid.org/0000-0001-9957-5741
  • Rute Alves Serviço de Cuidados Intensivos – Unidade de Cuidados Intermédios Médico-Cirúrgica, Centro Hospitalar e Universitário do Porto, Porto, Portugal https://orcid.org/0000-0001-9099-7075
  • Daniel G. Oliveira Serviço de Medicina, Centro Hospitalar e Universitário do Porto, Porto, Portugal https://orcid.org/0000-0002-3561-0250
  • Mariana Brandão Unidade de Imunologia Clínica, Centro Hospitalar e Universitário do Porto, Porto, Portugal; UMIB – Unit for Multidisciplinary Research in Biomedicine, Porto, Portugal https://orcid.org/0000-0003-2016-6932
  • Pedro Vita Unidade de Imunologia Clínica, Centro Hospitalar e Universitário do Porto, Porto, Portugal; Serviço de Cuidados Intensivos – Unidade de Cuidados Intermédios Médico-Cirúrgica, Centro Hospitalar e Universitário do Porto, Porto, Portugal https://orcid.org/0000-0001-9647-4865
  • António Marinho Unidade de Imunologia Clínica, Centro Hospitalar e Universitário do Porto, Porto, Portugal; UMIB – Unit for Multidisciplinary Research in Biomedicine, Porto, Portugal https://orcid.org/0000-0002-3295-6723

DOI:

https://doi.org/10.24950/rspmi/P.Vista/COVID19/79/20/CHP/S/2020

Keywords:

Baricitinib, Coronavirus, Coronavirus Infection, Cytokines, Immunomodulation, Interleukin 1 Receptor Antagonist Protein, Steroids, Tocilizumab

Abstract

The COVID-19 pandemic is a serious public health problem worldwide, for which there is no effective therapies. About 20%-33% of patients are admitted to intensive care units and in these the mortality rate is higher than 25%. Death caused directly by the COVID-19 results, in most cases, from an inappropriate hyperinflammatory response to the infection, with the release of cytokines. Due to the parallelism with other immune-mediated inflammatory diseases, the authors made a critical review of the pathophysiological mechanisms involved and potential situations where the use of immuno- modulators, in a narrow window of opportunity, may change the prognosis of some patients.

Downloads

Download data is not yet available.

References

ProMED-mail ProMED-mail2020 [updated 7 January 2020] [acces- sed 10/04/2020]. Available from: https://promedmail.org/promed-post/?id=6864153.

Ruan Q, Yang K, Wang W, Jiang L, Song J. Clinical predictors of mortality due to COVID-19 based on an analysis of data of 150 patients from Wuhan, China. Intensive Care Med. 2020 (in press). doi: 10.1007/s00134-020- 05991-x

Chen N, Zhou M, Dong X, Qu J, Gong F, Han Y, et al. Epidemiological and clinical characteristics of 99 cases of 2019 novel coronavirus pneumonia in Wuhan, China: a descriptive study. Lancet. 2020;395:507-13.

Mehta P, McAuley DF, Brown M, Sanchez E, Tattersall RS, Manson JJ, et al. COVID-19: consider cytokine storm syndromes and immunosuppression. Lancet. 2020;395:1033-4.

worldometer [accessed 12/04/2020 ]Available from: https://www.worldometers.info/coronavirus/.

Rodriguez-Morales AJ, Cardona-Ospina JA, Gutiérrez-Ocampo E, Villamizar-Peña R, Holguin-Rivera Y, Escalera-Antezana JP, et al. Clinical, laboratory and imaging features of COVID-19: A systematic review and meta-analysis. Travel Med InfectDis. 2020 (in press). doi: 10.1016/j.tmaid.2020.101623.

Grasselli G, Zangrillo A, Zanella A, Antonelli M, Cabrini L, Castelli A, et al. Baseline Characteristics and Outcomes of 1591 Patients Infected With SARS-CoV-2 Admitted to ICUs of the Lombardy Region, Italy. JAMA. 2020 (in press). doi: 10.1001/jama.2020.5394.

Richardson S, Hirsch JS, Narasimhan M, Crawford JM, McGinn T, Davidson KW, et al. Presenting Characteristics, Comorbidities, and Outcomes Among 5700 Patients Hospitalized With COVID-19 in the New York City Area.. 2020 (in press). doi: 10.1001/jama.2020.6775.

Angus DC. Optimizing the trade-off between learning and doing in a pandemic. JAMA. 2020 (in press). doi: 10.1001/jama.2020.4984.

World Health Organization. Off-label use of medicines for COVID-19: scientific brief, 31 March 2020. Geneva: World Health Organization; 2020 2020. Contract No.: WHO/2019-nCoV/Sci_Brief/Off-label_use/2020.1. Geneve: WHO; 2020.

Siddiqi HK, Mehra MR. COVID-19 Illness in Native and Immunosuppressed States: A Clinical-Therapeutic Staging Proposal. J Heart Lung Transpl. 2020 (in press).

Gattinoni L, Coppola S, Cressoni M, Busana M, Rossi S, Chiumello D. Covid19 does not lead to a ”typical” acute respiratory distress syndrome. Am J Respir Crit Care Med. 2020 (in press). doi: 10.1164/rccm.202003-0817LE.

Tseng YT, Sheng WH, Lin BH, Lin CW, Wang JT, Chen YC, et al. Causes, clinical symptoms, and outcomes of infectious diseases associated with hemophagocytic lymphohistiocytosis in Taiwanese adults. J Microbiol Immunol Infect. 2011;44:191-7.

Riviere S, Galicier L, Coppo P, Marzac C, Aumont C, Lambotte O, et al. Reactive hemophagocytic syndrome in adults: a retrospective analysis of 162 patients. Am J Med. 2014;127:1118-25.

Ramos-Casals M, Brito-Zeron P, Lopez-Guillermo A, Khamashta MA, Bosch X. Adult haemophagocytic syndrome. Lancet. 2014;383:1503-16.

Rouphael NG, Talati NJ, Vaughan C, Cunningham K, Moreira R, Gould C. Infections associated with haemophagocytic syndrome. Lancet Infect Dis. 2007;7:814-22.

La Rosee P, Horne A, Hines M, von Bahr Greenwood T, Machowicz R, Berliner N, et al. Recommendations for the management of hemophagocytic lymphohistiocytosis in adults. Blood. 2019;133:2465-77.

Machowicz R, Janka G, Wiktor-Jedrzejczak W. Similar but not the same: Differential diagnosis of HLH and sepsis. Crit Rev Oncol Hematol. 2017;114:1- 12.

Park HS, Kim DY, Lee JH, Lee JH, Kim SD, Park YH, et al. Clinical features of adult patients with secondary hemophagocytic lymphohistiocytosis from causes other than lymphoma: an analysis of treatment outcome and prognostic factors. Ann Hematol. 2012;91:897-904.

Henderson LA, Canna SW, Schulert GS, Volpi S, Lee PY, Kernan KF, et al. On the alert for cytokine storm: Immunopathology in COVID19. Arthritis Rheumat.2020 (in press) doi: 10.1002/art.41285.

Slaats J, Ten Oever J, van de Veerdonk FL, Netea MG.IL-1beta/IL-6/CRP and IL-18/ferritin: Distinct Inflammatory Programs in Infections. PLoS Pa- thog. 2016;12:e1005973.

Fardet L, Galicier L, Lambotte O, Marzac C, Aumont C, Chahwan D, et al. Development and validation of the HScore, a score for the diagnosis of reac- tive hemophagocytic syndrome. Arthritis Rheumatol. 2014;66:2613-20.

Wu C, Chen X, Cai Y, Xia Ja, Zhou X, Xu S, et al. Risk Factors Associa- ted With Acute Respiratory Distress Syndrome and Death in Patients With Coronavirus Disease 2019 Pneumonia in Wuhan, China. JAMAIntern Med. 2020 (in press). doi: 10.1001/jamainternmed.2020.0994.

Wang M, Cao R, Zhang L, Yang X, Liu J, Xu M, et al. Remdesivir and chloro- quine effectively inhibit the recently emerged novel coronavirus (2019-nCoV) in vitro. Cell Res. 2020;30:269-71.

Tang W, Cao Z, Han M, Wang Z, Chen J, Sun W, et al. Hydroxychloroquine in patients with COVID-19: an open-label, randomized, controlled trial. me- dRxiv. 2020:2020.04.10.20060558.

Zhou D, Dai SM, Tong Q. COVID-19: a recommendation to examine the effect of hydroxychloroquine in preventing infection and progression. J Antimicrob Chemother. 2020 (in press). doi: 10.1093/jac/dkaa114.

Cortegiani A, Ingoglia G, Ippolito M, Giarratano A, Einav S. A systematic review on the efficacy and safety of chloroquine for the treatment of COVID19. J Crit Care. 2020 (in press). doi: 10.1016/j.jcrc.2020.03.005.

Wolfe F, Marmor MF. Rates and predictors of hydroxychloroquine retinal toxicity in patients with rheumatoid arthritis and systemic lupus erythematosus. Arthritis Care Res. 2010;62:775-84.

Holt PJ. Chloroquine in rheumatic disease. Lancet. 1979;1:502.

Haładyj E, Sikora M, Felis-Giemza A, Olesinska M. Antimalarials - are they effective and safe in rheumatic diseases? Reumatologia. 2018;56:164-73.

Gao J, Tian Z, Yang X. Breakthrough: Chloroquine phosphate has shown apparent efficacy in treatment of COVID-19 associated pneumonia in clinical studies. Biosci Trends. 2020;14:72-3.

Gautret P, Lagier JC, Parola P, Hoang VT, Meddeb L, Mailhe M, et al. Hydroxychloroquine and azithromycin as a treatment of COVID-19: results of an open-label non-randomized clinical trial. Int J Antimicrob Agents. 2020 (in press). doi: 10.1016/j.ijantimicag.2020.105949.

Mahevas M, Tran V-T, Roumier M, Chabrol A, Paule R, Guillaud C, et al. No evidence of clinical efficacy of hydroxychloroquine in patients hospitalized for COVID-19 infection with oxygen requirement: results of a study using routinely collected data to emulate a target trial. medR- xiv.2020:2020.04.10.20060699.

Borba MG, Sampaio VS, Alexandre MA; Melo GC, Brito M, et al, CloroCovid-19 Team. Chloroquine diphosphate in two different dosages as adjunctive therapy of hospitalized patients with severe respiratory syndrome in the context of coronavirus (SARS-CoV-2) infection: Preliminary safety results of a randomized, double-blinded, phase IIb clinical trial (CloroCovid-19 Study). medrxiv. 2020.

Kim AHJ, Sparks JA, Liew JW, Putman MS, Berenbaum F, Duarte-Garcia A, et al. A Rush to judgment? rapid reporting and dissemination of results and its consequences regarding the use of hydroxychloroquine for COVID-19. Ann Intern Med. 2020 (in press). doi: 10.7326/M20-1223.

Meduri GU, Annane D, Chrousos GP, Marik PE, Sinclair SE. Activation and regulation of systemic inflammation in ARDS: rationale for prolonged glucocorticoid therapy. Chest. 2009;136:1631-43.

Tsang KW, Ho PL, Ooi GC, Yee WK, Wang T, Chan-Yeung M, et al. A cluster of cases of severe acute respiratory syndrome in Hong Kong. New Engl J Med. 2003;348:1977-85.

Arabi YM, Mandourah Y, Al-Hameed F, Sindi AA, Almekhlafi GA, Hussein MA, et al. Corticosteroid Therapy for Critically Ill Patients with Middle East Respiratory Syndrome. Am J Respir Crit Care Med. 2018;197:757-67.

Lee N, Hui D, Wu A, Chan P, Cameron P, Joynt GM, et al. A major out- break of severe acute respiratory syndrome in Hong Kong. New Engl J Med. 2003;348:1986-94.

Wang Y, Jiang W, He Q, Wang C, Wang B, Zhou P, et al. Early, low-dose and short-term application of corticosteroid treatment in patients with se- vere COVID-19 pneumonia: single-center experience from Wuhan, China. medRxiv.2020:2020.03.06.20032342.

Ferro F, Elefante E, Baldini C, Bartoloni E, Puxeddu I, Talarico R, et al.COVID-19: the new challenge for rheumatologists. Clinical Exp Rheumatol. 2020;38:175-80.

Sarzi-Puttini P, Giorgi V, Sirotti S, Marotto D, Ardizzone S, Rizzardini G, et al. COVID-19, cytokines and immunosuppression: what can we learn from severe acute respiratory syndrome? Clinical Exp Rheumatol. 2020;38:337-42.

Cavalli G, Dinarello CA. Anakinra Therapy for Non-cancer Inflammatory Diseases. Front Pharmacol. 2018;9:1157.

Shakoory B, Carcillo JA, Chatham WW, Amdur RL, Zhao H, Dinarello CA, et al. Interleukin-1 Receptor Blockade Is Associated With Reduced Mortality in Sepsis Patients With Features of Macrophage Activation Syndrome: Rea- nalysis of a Prior Phase III Trial. Crit Care Med. 2016;44:275-81.

Ogilvie AC, Hack CE, Wagstaff J, van Mierlo GJ, Erenberg AJ, Thomsen LL, et al. IL-1 beta does not cause neutrophil degranulation but does lead to IL-6, IL-8, and nitrite/nitrate release when used in patients with cancer. J Immunol. 1996;156:389-94.

Sironi M, Breviario F, Proserpio P, Biondi A, Vecchi A, Van Damme J, et al. IL-1 stimulates IL-6 production in endothelial cells. Journal Immunol. 1989;142:549-53.

Larsen CM, Faulenbach M, Vaag A, Volund A, Ehses JA, Seifert B, et al. Interleukin-1-receptor antagonist in type 2 diabetes mellitus. New Engl J Med. 2007;356:1517-26.

Launay D, Dutoit-Lefevre V, Faure E, Robineau O, Hauspie C, Sobanski V, et al. Effect of in vitro and in vivo anakinra on cytokines production in Schnitzler syndrome. PloSOne. 2013;8:e59327.

Norelli M, Camisa B, Barbiera G, Falcone L, Purevdorj A, Genua M, et al.Monocyte-derived IL-1 and IL-6 are differentially required for cytokine-release syndrome and neurotoxicity due to CAR T cells. Nature Med. 2018;24:739-48.

Carter SJ, Tattersall RS, Ramanan AV. Macrophage activation syndrome in adults: recent advances in pathophysiology, diagnosis and treatment. Rheumatology. 2018;58:5-17.

Bauchmuller K, Manson JJ, Tattersall R, Brown M, McNamara C, Singer M, et al. Haemophagocytic lymphohistiocytosis in adult critical care. J Intensive Care Soc. 2020:1751143719893865.

Fu B, Xu X, Wei H. Why tocilizumab could be an effective treatment for severe COVID-19? J Transl Med. 2020;18:164.

Luo P, Liu Y, Qiu L, Liu X, Liu D, Li J. Tocilizumab treatment in COVID-19: A single center experience. J Med Virol. 2020 (in press). doi: 10.1002/jmv.25801.

Campbell L, Chen C, Bhagat SS, Parker RA, Ostor AJ. Risk of adverse events including serious infections in rheumatoid arthritis patients treated with tocilizumab: a systematic literature review and meta-analysis of randomized controlled trials. Rheumatology. 2011;50:552-62.

Mohan S MM, Yourish J, Pei J, Gale S, Birchwood C, Berber E. Long-Term Safety of Tocilizumab from Large Clinical Trial and Postmarketing Popula- tions. Arthritis Rheumatol. 2017;69.

Le RQ, Li L, Yuan W, Shord SS, Nie L, Habtemariam BA, et al. FDA Approval Summary: Tocilizumab for Treatment of Chimeric Antigen Receptor T Cell-Induced Severe or Life-Threatening Cytokine Release Syndrome. Oncolo- gist. 2018;23:943-7.

Richardson P, Griffin I, Tucker C, Smith D, Oechsle O, Phelan A, et al. Ba- ricitinib as potential treatment for 2019-nCoV acute respiratory disease. Lancet.2020;395:e30-e1.

Moreno I. [accessed 12/04/2020] Available from: https://youtu.be/sPeu- EwKkYYU].

Downloads

Published

2021-12-21

How to Cite

1.
Faria R, Carvalheiras G, Alves R, G. Oliveira D, Brandão M, Vita P, Marinho A. Window of Opportunity for Immunodulatory Therapy in COVID-19. RPMI [Internet]. 2021 Dec. 21 [cited 2024 Nov. 23];:35-41. Available from: https://revista.spmi.pt/index.php/rpmi/article/view/218

Issue

2020: Special Issue - COVID 19

Section

Points of View

License

Creative Commons License

This work is licensed under a Creative Commons Attribution 4.0 International License.

Copyright (c) 2023 Medicina Interna

Open Access