Experts find anti-inflammatories might save lives in late-stage COVID-19

ROME - With the coronavirus pandemic raging for months, scientists around the world have been working around the clock to fast-track coronavirus treatments and vaccine to contain the disease.

As the understanding of the virus deepens, scientists have found that in a minority of patients, the new coronavirus can trigger Cytokine Release Syndrome (CRS), an overreaction of the immune system, also known as a cytokine storm that can cause massive organ failure.

In several recent clinical studies, scientists in some countries found that the arthritis drug tocilizumab has shown promising results in preventing extreme inflammation in gravely ill COVID-19 patients.

Tocilizumab, a human-designed protein commonly used to treat rheumatoid arthritis by blocking the body's inflammatory responses, has been chosen by experts to combat CRS in late-stage COVID-19 patients.

In a late April research carried out by the Paris university hospital trust (AP-HP), scientists looked at 129 people hospitalized with moderate-to-severe viral pneumonia as a result of the coronavirus.

Half of the 129 people were given two injections of tocilizumab as well as normal antibiotic treatment, while the other half only received the standard antibiotic treatment.

The team did not release the precise results, but noted that it showed clear "clinical benefit" of tocilizumab treatment.

Mandeep R. Mehra, medical director of the Brigham and Women's Hospital Heart and Vascular Center, has suggested a three-stage classification system for the illness as COVID-19 exhibits three grades of increasing severity, each requiring its own tailored therapy.

"A minority of COVID-19 patients will transition into the third and most severe stage of the illness, which manifests as an extrapulmonary systemic hyperinflammation syndrome," he wrote in an article published on March 20 in the Journal of Heart and Lung Transplantation, citing a report from the China Center for Disease Control and Prevention.

Tailored therapy in Stage 3 COVID-19 hinges on reducing "systemic inflammation before it overwhelmingly results in multi-organ dysfunction," wrote Mehra, who is also a professor of medicine at Harvard Medical School.

He suggested using cytokine inhibitors "such as tocilizumab or anakinra" -- both used to treat rheumatoid arthritis -- to reduce the number of death and life support interventions.

Paolo Ascierto, director of the Unit of Melanoma, Cancer Immunotherapy and Innovative therapy at the National Tumour Institute "G. Pascale Foundation" in Naples, told Xinhua in an interview that people started seeing reactions linked to "a hyper-activation of the immune system" with the advent of immunotherapy in oncology.

"Tocilizumab is a drug we are very familiar with, because we use it to treat CRS stemming from antibody treatments in immunotherapeutic clinical trials," Ascierto said, adding that he noticed the "cytokine storm is similar to that which develops due to Acute Respiratory Distress Syndrome from COVID-19."

"This is how we arrived at the idea (of using tocilizumab to treat COVID-19 patients)," he said.

Ascierto said his team had consulted with its Chinese colleagues at the beginning of the first wave of COVID-19.

He said he is waiting for results validated by drug authorities and those results "will tell us if the medication is scientifically valid," Ascierto said.