In a new study, researchers found that most patients hospitalized with COVID-19 (coronavirus) pneumonia experienced improvement after receiving a Food and Drug Administration-approved drug normally given for rheumatoid arthritis.
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 linked to severely ill COVID-19 patients.
The research was conducted by a team at Cedars-Sinai.
Scientists have been studying tocilizumab for a decade, focusing on its use for rheumatoid arthritis and cytokine storms with cancer.
The medication was approved in 2010 by the FDA as a treatment for rheumatoid arthritis.
In the study, the team examined laboratory and clinical changes 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, compared with reports of patients not treated with tocilizumab.
They 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.
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, healthcare professionals discovered that cytokine storms were causing a rapid deterioration in some patients.
The key to patient survival, investigators are learning, is to keep that storm from gathering strength.
The team found 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.
Post-treatment results showed that 23 patients experienced significant drops in body temperature and C-reactive protein (CRP) levels. CRP levels increase when an infection is present in the body.
Four patients did not have rapid declines in CRP levels, and three of them had poorer outcomes. Adverse events were minimal, but two deaths unrelated to tocilizumab occurred.
The study suggests the drug may help reduce inflammation, oxygen requirements, blood pressure support, and the risk of death.
One author of the study is Stanley Jordan, MD, the director of the Cedars-Sinai Nephrology and Transplant Immunology Programs.
The study is published in Clinical Infectious Diseases.
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