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.

Lights and Shadows on Managing Immune Checkpoint Inhibitors in Oncology during the COVID-19 Era.

Since the start of the global spread of coronavirus disease (COVID-19) pandemic, cancer patients were identified as a specifically susceptible subgroup of the patient population. Several reports have shown that cancer patients have an increased risk of both contracting the infection and of experiencing a more severe disease course, with a rapidly evolving picture associated with higher mortality. The assumption of cancer patients as "COVID-19 vulnerable" has led, irretrievably, to profound changes in the decision making of oncological treatments. Potential justifications for such concerns encompass the cancer-dependent suppression of the immune response, as well as the influence of administration of systemic anticancer treatments, including chemotherapy and immunotherapy. Nevertheless, to date, it is not clear whether the use of immune checkpoint inhibitors (ICIs) in cancer patients is safe, given their modulating effects on the immune system, or that they may rather conceal detrimental consequences. Theoretically, on the one hand, ICIs may enhance the immunological control of viral infections through their immunostimulating mechanisms; on the other hand, they could contribute to the hyper-inflammatory phase of COVID-19, worsening its clinical outcomes. In this study, we report the foremost clinical observations on the safety of ICI administration in cancer patients affected by COVID-19.