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: https://doi.org/10.1101/2020.04.01.20047381
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.