Research Update: Cytokine Storm Syndrome

September 28, 2020

Various drug therapies, including several cytokine blockers, are showing promise in addressing COVID-19 related cytokine storm syndrome, says Dr. Randall Cron of Children’s Hospital of Alabama.

Various drug therapies, including several cytokine blockers, are showing promise in addressing cytokine storm syndrome brought on by COVID-19, says Randall Cron, M.D., Ph.D., a rheumatologist and researcher with Children’s Hospital of Alabama.

According to a May analysis appearing in Arthritis & Rheumatology, intensive care admissions and deaths in severe cases of COVID-19 can be triggered by lymphopenia and elevated blood levels of transaminases, lactate dehydrogenase, d-dimer, ferritin, and soluble interleukin‐2 receptor. These also can signal cytokine storm syndrome, which is generally defined as hyperinflammation and multiorgan disease precipitated by an uncontrolled immune activation, which in turn causes a massive release of cytokines.

Early analyses of several treatment options have borne some fruit. A multivariable Cox regression analysis published in August by The Lancet found an association between exposure to tocilizumab, an IL-6 cytokine blocker, and decreased hospital mortality (HR 0.64 [95% CI] 0.47-0.87, p=0.004).

A total of 630 patients were divided into a group that received tocilizumab (210) and did not (420). Of the 358 (57%) patients who died, 102 (49%) received tocilizumab and 256 (61%) did not.

In addition, IL-1 and GM-CSF blockers have been shown to increase the odds of survival, Dr. Cron said. So, too, have JAK/STAT inhibitors. Cyclosporine and tacrolimus have demonstrated potential in small early studies.

Early short-course corticosteroids have seen mixed results in early research, Dr. Cron said. Although glucocorticoids are a mainstay of treatment, the US Centers for Disease Control and Prevention has recommended against their use for COVID‐19.

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REFERENCE

Congress of Clinical Rheumatology East, September 2020. "COVID-19 Cytokine Storm Syndrome”