Following encouraging preliminary results from a clinical study, French physicians from AP-HP hope that an anti-inflammatory drug called tocilizumab can significantly improve the treatment of patients with moderate to severe COVID-19 pneumonia. This drug, which is only administered in hospitals, could be useful in preventing patients with a severe form of COVID-19 from deteriorating to the point where they need to be admitted to intensive care.
The vast majority of people infected with the new coronavirus develop a mild form of Covid-19, but of the patients discovered so far, 15% will need to be hospitalized, 5% of whom will need to be admitted to intensive care because of a severe form. In addition to possible associated pathologies that complicate their clinical situation (obesity, hypertension, etc.), the body’s own defense system seems to be involved in these patients. In fact, the deterioration of the respiratory disease observed in some patients about a week after the onset of symptoms is not only linked to the virus, but also to an exaggerated immune response.
This phenomenon is known as “cytokine storm”, a phenomenon related to the overproduction of certain inflammatory mediators (cytokines), including interleukin-6 (IL-6). In patients with COVID-19 pneumonia, experts believe that this cytokine storm of immunological origin leads to complications, acute lung failure and even death. The promising progress of a treatment against this phenomenon already on the market has been announced by the Assistance Publique-Hôpitaux de Paris (AP-HP) within the CORIMUNO-19 program, which aims to test the efficacy and tolerability of various immunomodulating drugs in patients with severe COVID-19 infection.
A medicine for rheumatoid arthritis
As a result a number of studies have been conducted since 27 March, and the PA-HP announcement concerns a study based on the use of a drug called tocilizumab (Actemra) from the Roche laboratory, although the results have yet to be published in a scientific journal. “In light of the pandemic, researchers and the sponsor felt an ethical obligation to share this information until peer review, while continuing the longer follow-up of these patients,” PA-HP said. These preliminary results were also communicated to the French health authorities and the World Health Organization.
How does this drug work? It is already used in rheumatoid arthritis and binds specifically to interleukin (IL)-6 receptors. A pro-inflammatory cytokine (a substance that is synthesized by some cells of the immune system and acts on other immune cells to regulate their activity) that acts as a regulator of inflammation, fever, sleep, hematopoiesis (formation of blood cells), or bone destruction. The role of IL-6 in the pathogenesis of diseases, including inflammation, osteoporosis and neoplasia, has been demonstrated.
A potential treatment that is not yet approved
The selected patients had to meet a certain criterion: They had to be admitted to a hospital with moderate or severe COVID-19 pneumonia and be receiving oxygen, but their medical condition has not required admission to intensive care yet at the time of admission. 129 patients were enrolled in this study called “Corimuno-Toci”: 65 received the usual treatment plus tocilizumab and 64 just the usual treatment.
“The number of patients who needed resuscitation and the number of patients who died were significantly reduced. This is very positive”, Prof. Olivier Hermine, hematologist at Necker Hospital, who participated in the study, told the newspaper Le Parisien.
The patients in the first group were monitored for 14 days and the doctors did not notice any significant side effects. However, the doctors stressed to Le Parisien that tocilizumab is not without risks: “It may increase the risk of bacterial infection or liver problems. In any case, tocilizumab should not be taken as self-medication. “
Even though these results were published in a journal, they still need to be confirmed by additional studies. However, AP-HP points out that other CORIMUNO studies testing other IL-6 receptor inhibiting therapies are nearing completion.