Applicance of Science when an Autoimmune Drug helps


Neuromyelitis optica and Rheumatiod arthritis drug comes to the aid of people with severe covid-19. It seems that the most dangerous element of COVID-19 is when your body attacks the virus about 10 days after onset of symptoms. My guess is that the virus is all over the place by then and you start to damage the lining of your lungs in some instances. The immune response goes into over drive and this is fuelled by a cytokine storm. One of the cytokines is called interleukin 6 and this helps to cause fever and c-reactive protein that are both elevated in severe COVID-19.

There one approach to therapy is to block inteleukin 6 activity and this can be done using antibodies against the interleukin 6 receptor.

Level of IL-6 predicts respiratory failure in hospitalized symptomatic COVID-19 patients Tobias Herold III, Vindi Jurinovic, Chiara Arnreich, Johannes C Hellmuth, Michael Bergwelt-Baildon, Matthias Klein, Tobias Weinbergerdoi:

The pandemic Coronavirus-disease 19 (COVID-19) is characterized by a heterogeneous clinical course. While most patients experience only mild symptoms, a relevant proportion develop severe disease progression with increasing hypoxia up to acute respiratory distress syndrome. The substantial number of patients with severe disease have strained intensive care capacities to an unprecedented level. Owing to the highly variable course and lack of reliable predictors for deterioration, we aimed to identify variables that allow the prediction of patients with a high risk of respiratory failure and need of mechanical ventilation Patients with PCR proven symptomatic COVID-19 infection hospitalized at our institution from 29th February to 27th March 2020 (n=40) were analyzed for baseline clinical and laboratory findings. Patients requiring mechanical ventilation 13/40 (32.5%) did not differ in age, comorbidities, radiological findings, respiratory rate or qSofa score. However, elevated interleukin-6 (IL-6) was strongly associated with the need for mechanical ventilation (p=1.2.10-5). In addition, the maximal IL-6 level (cutoff 80 pg/ml) for each patient during disease predicted respiratory failure with high accuracy (p=1.7.10-8, AUC=0.98). The risk of respiratory failure for patients with IL-6 levels of ≥ 80 pg/ml was 22 times higher compared to patients with lower IL-6 levels. In the current situation with overwhelmed intensive care units and overcrowded emergency rooms, correct triage of patients in need of intensive care is crucial. Our study shows that IL-6 is an effective marker that might be able to predict upcoming respiratory failure with high accuracy and help physicians correctly allocate patients at an early stage.

The cytokine release syndrome (CRS) of severe COVID-19 and Interleukin-6 receptor (IL-6R) antagonist Tocilizumab may be the key to reduce the mortality.Zhang C, Wu Z, Li JW, Zhao H, Wang GQ.Int J Antimicrob Agents. 2020 Mar 29:105954.

New therapeutic opportunities for COVID-19 patients with Tocilizumab: Possible correlation of interleukin-6 receptor inhibitors with osteonecrosis of the jaws. Bennardo F, Buffone C, Giudice A. Oral Oncol. 2020 Mar 21:104659. doi: 10.1016/j.oraloncology.2020.104659. [Epub ahead of print] No abstract available.PMID: 32209313

Anti-IL6R role in treatment of COVID-19-related ARDS. Buonaguro FM, Puzanov I, Ascierto PA.J T ransl Med. 2020 Apr 14;18(1):165. 

Why tocilizumab could be an effective treatment for severe COVID-19?Fu B, Xu X, Wei H.J Transl Med. 2020 Apr 14;18(1):164. 

Rapid and Severe Covid-19 Pneumonia with Severe Acute Chest Syndrome in a Sickle Cell Patient Successfully Treated with Tocilizumab.De Luna G, Habibi A, Deux JF, Colard M, d’Alexandry d’Orengiani ALPH, Schlemmer F, Joher N, Kassasseya C, Pawlotsky JM, Ourghanlian C, Michel M, Mekontso-Dessap A, Bartolucci P.Am J Hematol. 2020 Apr 13. doi: 10.1002/ajh.25833.

There are loads more and then there could be another arthritis drug that people want to test and this is anti-Tumour necrosis factor. This experiment must have been done already as there must be loads of people with arthritis and other conditions taking this drug did they avoid severe COVID-19.

It seems atleast some rheumatologists are giving different advice to the MS ologists in the UK.

Rheumatologists’ perspective on coronavirus disease 19 (COVID-19) and potential therapeutic targets. Misra DP, Agarwal V, Gasparyan AY, Zimba O. Clin Rheumatol. 2020 Apr 10. doi: 10.1007/s10067-020-05073-9. [Epub ahead of print] Review.

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  • Maybe the “auto-immune” drugs ~work because of their anti-viral properties, like the chloroquine, no?

    • I think that when the virus overcomes the first line of immune defense, especially for having a weak immune system, like that of the elderly. Then it spreads throughout the body in the following days, in the end the body desperately generates a large immune response. It may be a mechanism similar to multiple sclerosis, and it may be hinting at the viral origin of the syndrome.

      • Actemra anti-cytokine storm cancer drug saved stricken ER doctor.

        “This is a movie-like save, it doesn’t happen in the real world often,” Padgett said. “I was just a fortunate recipient of people who said, ‘We are not done. We are going to go into an experimental realm to try and save your life.’

        “Based on the astronomical level of inflammation in his body and reports written by Chinese and Italian physicians who had treated the sickest COVID-19 patients, the doctors came to believe that it was not the disease itself killing him but his own immune system.

        It had gone haywire and began to attack itself — a syndrome known as a “cytokine storm.”

        The immune system normally uses proteins called cytokines as weapons in fighting a disease. For unknown reasons in some COVID-19 patients, the immune system first fails to respond quickly enough and then floods the body with cytokines, destroying blood vessels and filling the lungs with fluid.

        The doctors tried a drug called Actemra, which was designed to treat rheumatoid arthritis but also approved in 2017 to treat cytokine storms in cancer patients.

        “Our role was to quiet the storm,” said Dr. Samuel Youssef, a cardiac surgeon. “Dr. Padgett was able to clear the virus” once his immune system was back in balance.”

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