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Rethinking interleukin-6 blockade for treatment of COVID-19
#MMPMID32758889
Scherger S
; Henao-Martínez A
; Franco-Paredes C
; Shapiro L
Med Hypotheses
2020[Nov]; 144
(?): 110053
PMID32758889
show ga
Interleukin-6 (IL-6) is a pleiotropic cytokine with effects in immune regulation,
inflammation, and infection. The use of drugs that inhibit IL-6 biological
activity has been proposed as a treatment for patients with Coronavirus Disease
2019 (COVID-19). The rationale for this approach includes commitment to the
concept that inflammation is a cause of lung damage in COVID-19 and belief that
IL-6 is a pro-inflammatory molecule. Observational data thought to support IL-6
inhibition include elevated circulating IL-6 levels in COVID-19 patients and
association between elevated IL-6 and poor clinical outcomes. However, IL-6 has
significant anti-inflammatory properties, which calls into question the rationale
for employing IL-6 blockade to suppress inflammation-induced tissue injury. Also,
studies suggesting a beneficial role for IL-6 in the host response to infection
challenge the strategy of using IL-6 blockade to treat COVID-19. In studies of
recombinant IL-6 injected into human volunteers, IL-6 levels exceeding those
measured in COVID-19 patients have been observed with no pulmonary adverse events
or other organ damage. These observations question the role of IL-6 as a
contributing factor in COVID-19. Clinical experience with IL-6 receptor
antagonists such as tocilizumab demonstrates increase in severe and opportunistic
infections, raising concern about using tocilizumab and similar agents to treat
COVID-19. Trials of drugs to inhibit IL-6 activity in COVID-19 are ongoing and
will shed light on the role of IL-6 in COVID-19 pathogenesis. However, until more
information is available, providers should exercise caution in prescribing these
therapies given the potential for patient harm.
|*COVID-19 Drug Treatment
[MESH]
|Antibodies, Monoclonal, Humanized/therapeutic use
[MESH]
free
free
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