In a new study, researchers found a new way to treat patients with COVID-19-associated Cytokine storm syndrome (CSS).
They found that a treatment strategy combining intensive immunosuppression (using glucocorticoids and an IL-6 inhibitor) as well as close monitoring dramatically improves patient outcomes when compared to supportive care only.
This new treatment can reduce hospital mortality by 65%.
Moreover, it shows that clinically relevant improvement of respiratory status is 79% more likely than with standard of care alone and can be accelerated by a median of seven days.
Additionally, the need for mechanical ventilation during admission could be reduced by 71%.
The research was conducted by a team at Zuyderland Medical Center (ZMC) in the Netherlands.
Poor outcomes in people with COVID-19 is linked to a state of systemic hyper inflammation reminiscent of a cytokine storm syndrome (CSS) that has been reported previously as a rare and potentially lethal complication of various infections, malignancies and autoimmune diseases.
Immune hyperreactivity is an important complication of COVID-19 in up to 25% of affected patients, often responsible for a fatal outcome.
In the study, a 40% mortality rate amongst critically ill patients with COVID-19 associated CCS has observed under supportive care “only” treatment by the end of March 2020.
The team detailed the results of 86 patients with COVID-associated-CSS who were treated with glucocorticoids (and in some cases an IL-6 inhibitor) from the start of April, 2020.
These have been compared with the patient outcomes of a control group of 86 patients, who received supportive care ‘only’.
The findings showed that the sickest COVID-19 patients, namely those with signs of cytokine storm, had a dramatic beneficial effect on glucocorticoids.
The treatment included two steps. Firstly, treatment with glucocorticoids for between five and seven days.
Secondly, where necessary, the escalation of immunosuppressive treatment with an IL-6 inhibitor between day two and day five, with the possibility of an extension.
The study also highlights the importance of combining intensive immunosuppression with early intervention and close monitoring by a multidisciplinary team.
Until now, information about immunosuppressive treatment of COVID-19-associated CSS has only been anecdotal.
Several experts have warned against treating critically ill patients with a COVID-19 infection with glucocorticoids; advice which could have potentially serious implications for many patients.
While the study’s authors recognize that these results require a confirmation from more work, they believe that the outcomes are robust.
They also believe that the risk profile of such a short course of glucocorticoids for treatment of CSS needs to be separated from their pre-existing chronic use for conditions like rheumatic and musculoskeletal diseases.
The study’s recommendations are that CSS should be recognized and considered as a treatable complication of COVID-19 and that immunosuppressive treatment should be started timely.
Additionally, that short term treatment with high-dose glucocorticoids is a convenient choice since they are safe, widely available and inexpensive.
One author of the study is Professor Robert B.M. Landewé.
The study is published in The Annals of the Rheumatic Diseases.
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