Sarilumab administration in patients with severe COVID‑19: A report of four cases and a literature review

Almost 2 years have passed since the World Health Organization declared a pandemic state for severe acute respi‑ ratory syndrome coronavirus 2 infection. The pathogenesis of coronavirus disease 2019 (COVID‑19) consists of an initial viral phase responsible for early symptoms followed by an inflammatory phase, which is cytokine‑mediated, responsible for late‑onset symptoms, culminating in acute respiratory distress syndrome. Considering that IL‑6 plays a key‑role in the development and maintenance of inflammation, drugs targeting both IL‑6 and IL‑6 receptors have been evaluated. The present study reports the cases of four hospitalized patients with severe respiratory COVID‑19 treated with a single dose of sarilumab, a monoclonal anti‑IL‑6 antibody, along with standard of care medications and oxygen therapy. A few days following sarilumab administration, the clinical and biochem‑ ical conditions began to improve, until the discontinuation of O2 therapy and discharge. The present study demonstrates that sarilumab may represent a promising drug that may be used to treat the hyperinflammatory phase;however, further trials are required to determine whether it should be used combina‑ tion with other drugs or alone, and to better understand the pharmacokinetics and related side‑effects. [ FROM AUTHOR] Copyright of World Academy of Sciences Journal is the property of Spandidos Publications UK Ltd and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full . (Copyright applies to all s.)

Sarilumab Administration in COVID-19 Patients: Literature Review and Considerations.

Two years have passed since WHO declared a pandemic state for SARS-CoV-2 infection. COVID-19 pathogenesis consists of a first viral phase responsible for early symptoms followed by an inflammatory phase, cytokine-mediated, responsible for late-onset manifestations up to ARDS. The dysregulated immune response has an outstanding role in the progression of pulmonary damage in COVID-19. IL-6, through the induction of pro-inflammatory chemokines and cytokines, plays a key role in the development and maintenance of inflammation, acting as a pioneer of the hyperinflammatory condition and cytokine storm in severe COVID-19. Therefore, drugs targeting both IL-6 and IL-6 receptors have been evaluated in order to blunt the abnormal SARS-CoV-2-induced cytokine release. Sarilumab, a high-affinity anti-IL-6 receptor antibody, may represent a promising weapon to treat the fearsome hyperinflammatory phase by improving the outcome of patients with moderate-to-severe COVID-19 pneumonia. Further prospective and well-designed clinical studies with larger sample sizes and long-term follow-up are needed to assess the efficacy and the safety of this therapeutic approach to achieve improved outcomes in COVID-19.

Low Represented Mutation Clustering in SARS-CoV-2 B.1.1.7 Sublineage Group with Synonymous Mutations in the E Gene.

Starting in 2019, the COVID-19 pandemic is a global threat that is difficult to monitor. SARS-CoV-2 is known to undergo frequent mutations, including SNPs and deletions, which seem to be transmitted together, forming clusters that define specific lineages. Reverse-Transcription quantitative PCR (RT-qPCR) has been used for SARS-CoV-2 diagnosis and is still considered the gold standard method. Our Eukaryotic Host Pathogens Interaction (EHPI) laboratory received six SARS-CoV-2-positive samples from a Sicilian private analysis laboratory, four of which showed a dropout of the E gene. Our sequencing data revealed the presence of a synonymous mutation (c.26415 C > T, TAC > TAT) in the E gene of all four samples showing the dropout in RT-qPCR. Interestingly, these samples also harbored three other mutations (S137L-Orf1ab; N439K-S gene; A156S-N gene), which had a very low diffusion rate worldwide. This combination suggested that these mutations may be linked to each other and more common in a specific area than in the rest of the world. Thus, we decided to analyze the 103 sequences in our internal database in order to confirm or disprove our "mutation cluster hypothesis". Within our database, one sample showed the synonymous mutation (c.26415 C > T, TAC > TAT) in the E gene. This work underlines the importance of territorial epidemiological surveillance by means of NGS and the sequencing of samples with clinical and or technical particularities, e.g., post-vaccine infections or RT-qPCR amplification failures, to allow for the early identification of these SNPs. This approach may be an effective method to detect new mutational clusters and thus to predict new emerging SARS-CoV-2 lineages before they spread globally.