LOS ANGELES — Most patients hospitalized with COVID-19 pneumonia experienced improvement after receiving a Food and Drug Administration-approved drug normally given for rheumatoid arthritis, Cedars-Sinai Medical Center reported Tuesday based on a new study.
Outcomes for patients who received the drug tocilizumab included reduced inflammation, oxygen requirements, blood pressure support and risk of death compared with published reports of illness and death associated with severely ill COVID-19 patients.
The single-center observational study of 27 patients was led by Dr. Stanley Jordan, director of the Cedars-Sinai Nephrology and Transplant Immunology Programs, and published June 23 in Clinical Infectious Diseases, Cedars said in a statement.
While the patient outcomes were encouraging, investigators said they were not sufficient to prove the drug was safe and effective for use in COVID-19 patients because they did not conduct a clinical trial with a control group.
The team examined laboratory and clinical changes — including oxygen levels, the need for medication to increase blood pressure and patient survival — in 27 patients with COVID-19 pneumonia who received the immunosuppressive drug tocilizumab to slow an out-of-control immune response. The researchers observed improved inflammatory markers and patient survival and compared them with reports of patients not treated with tocilizumab.
“Researchers have been studying tocilizumab for a decade, focusing on its use for rheumatoid arthritis and cytokine storms with cancer,” said Jordan, a Cedars-Sinai professor of medicine. The medication was approved in 2010 by the FDA as treatment for rheumatoid arthritis.
The Cedars-Sinai investigators found that interleukin 6 — a protein that fuels immune cell production and is the target for tocilizumab — was the main cytokine elevated in COVID-19 patients.
“Since tocilizumab blocks interleukin 6, we reasoned that it made sense to try it with COVID-19 pneumonia patients,” Jordan said.
Cytokines are molecules secreted by multiple cell types, including immune system cells that regulate the body’s immune response. A cytokine storm is a severe reaction in which immune cells flood and attack healthy organs they are supposed to protect. In COVID-19 patients, the virus stimulates immune cells that lead to collateral lung damage, which may cause blood vessels to leak and blood to clot. The patient’s blood pressure sinks and organs start to fail.
Early on in the COVID-19 pandemic, health-care professionals discovered that cytokine storms were causing rapid deterioration in some patients. The key to patient survival, investigators are learning, is to keep that storm from gathering strength.
Most of the patients who received tocilizumab were on ventilators to support breathing. They each received one dose of tocilizumab, which helps block the signaling of the cytokine, interleukin 6 — the only cytokine detected in damaging amounts in all of the study patients.
“The more interleukin 6 present in the body, the worse the patient outcome,” Jordan said.
Source: Orange County Register