The role of Interleukin 6 inhibitors in therapy of severe COVID-19
Fecha
2020Autor
Nasonov, E.
Samsonov, M.
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Resumen
Cytokine storm syndrome (CSS) is a severe complication of inflammatory immune diseases or
treatment of malignancies; it may also appear during the progression of COVID-19. CSS is caused
by dysregulation of the synthesis of cytokines, including pro-inflammatory, regulatory, and antiinflammatory cytokines and chemokines, leading to pathologic activation of innate and adaptive
(Th1 and Th17 mediated) immunity. Interleukin-6 (IL-6) plays an important role in the
pathogenesis of CSS. The significant role of IL-6 in pathogenesis of COVID-19 was confirmed in a
range of studies, which showed that the plasma concentration of IL-6 was increased in patients
with severe COVID-19. Currently, IL-6 inhibitor therapeutics are not yet approved for the
treatment of СOVID-19; however, these medicines, including tocilizumab (TCZ) are used off-label
for the treatment of patients with severe СOVID-19, including life-threatening conditions. The
role of IL-6 in the pathogenesis of CSS during COVID-19 is important however, a number of
related issues are not yet clear. These issues include the indications for treatment with IL-6
inhibitors, as well as the estimation of risk associated with the disease, outcomes, treatment
options, and adverse drug reactions. The development of personalized immunomodulatory
therapy, with respect to the role of cytokines in pathogenesis, requires the studies that aimed to
find other relevant therapeutic targets for the treatment of CSS in patients with COVID-19. These
therapeutic targets include inhibition of IL-1, IL-6, TNFα, GM-CSF, IFNγ, IL-17, IL-18, and also
activation of the complement system.
The challenge of CSS in patients with COVID-19 is identifying the correct scientific targets and
developing clinical trials aimed to evaluate the pathogenesis and treat immune-mediated
inflammatory diseases (IMIDs). Hopefully, the significant efforts of scientists and physicians
across the globe will improve the prognosis in COVID-19 patients and provide useful information
on IMIDs required to support the struggle for treating potential viral outbreaks, and treatment
of well-known IMIDs.
Keywords: COVID-19, interleukin 6, cytokine storm syndrome
2. Introduction
J
Palabras clave
COVID-19; Interleukin 6; Cytokine storm syndromeEnlace al recurso
https://doi.org/10.1016/j.biopha.2020.110698Colecciones
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