Can we use interleukin-6 (IL-6) blockade for coronavirus disease 2019 (COVID-19)-induced cytokine release syndrome (CRS)?

J Autoimmun. 2020 Jul;111:102452. doi: 10.1016/j.jaut.2020.102452. Epub 2020 Apr 10.

Abstract

The emergent outbreak of coronavirus disease 2019 (COVID-19) has caused a global pandemic. Acute respiratory distress syndrome (ARDS) and multiorgan dysfunction are among the leading causes of death in critically ill patients with COVID-19. The elevated inflammatory cytokines suggest that a cytokine storm, also known as cytokine release syndrome (CRS), may play a major role in the pathology of COVID-19. However, the efficacy of corticosteroids, commonly utilized antiinflammatory agents, to treat COVID-19-induced CRS is controversial. There is an urgent need for novel therapies to treat COVID-19-induced CRS. Here, we discuss the pathogenesis of severe acute respiratory syndrome (SARS)-induced CRS, compare the CRS in COVID-19 with that in SARS and Middle East respiratory syndrome (MERS), and summarize the existing therapies for CRS. We propose to utilize interleukin-6 (IL-6) blockade to manage COVID-19-induced CRS and discuss several factors that should be taken into consideration for its clinical application.

Keywords: Coronavirus disease 2019; Cytokine release syndrome; Interleukin-6; Tocilizumab.

Publication types

  • Research Support, Non-U.S. Gov't
  • Review

MeSH terms

  • Anti-Inflammatory Agents / therapeutic use
  • Antibodies, Monoclonal, Humanized / therapeutic use*
  • Betacoronavirus / pathogenicity
  • COVID-19
  • Coronavirus Infections / pathology*
  • Cytokine Release Syndrome / therapy*
  • Humans
  • Immunomodulation / drug effects
  • Interleukin-6 / antagonists & inhibitors*
  • Interleukin-6 / blood
  • Pandemics
  • Pneumonia, Viral / pathology*
  • SARS-CoV-2
  • Severe Acute Respiratory Syndrome / pathology

Substances

  • Anti-Inflammatory Agents
  • Antibodies, Monoclonal, Humanized
  • IL6 protein, human
  • Interleukin-6
  • tocilizumab