Research Update: Cytokine Storm Syndrome

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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”