WHO recommends the use of two rheumatologic drugs in severe cases of Covid

These drugs are what we call in the jargon immunomodulators. Not to mention that they are particularly expensive (in Argentina, 200 mg of tocilizumab starts at 65,000 pesos), the Ministry of Health of the Nation do not recommend, for now, its use in Argentina.

According to the official portfolio page headed by Carla Vizzotti, “to date, there is no evidence to make a recommendation for or against immunomodulatory therapies (IL-6 inhibitors, kinase inhibitors, etc.) except in the context of a clinical trial”. At the end of this note, Bugle had not been able to obtain a response on their intention to change this determination.

The truth is that the WHO launched this recommendation after coordinating a large study, which compiled 27 randomized trials in which they almost participated 11,000 patients: 6,449 received one of these two immunomodulators and 4,481 remained in the placebo group.

Everything was published this Tuesday in the prestigious Journal of the American Medical Association (JAMA), in an article entitled “Association between administration of interleukin-6 antagonists and mortality in hospitalized patients with COVID-19: a meta-analysis”.

The conclusions, depending on how you look at them, can be small or, conversely, be a spoonful of encouragement, in the midst of a pandemic that never wants to begin to recede.

Strong figures from the WHO study (in partnership with King’s College London, the Universities of Bristol and College London, and the Guy’s and St. Thomas’ NHS Foundation Trust) are a reduced risk of death for 17% in critically ill patients who used tocilizumab or sarilumab, compared to those who only used corticosteroids (dexamethasone).

In those without mechanical ventilation, the risk of needing to be ventilated or of dying was further reduced: 21%, always compared to the use of corticosteroids alone.

Notions

As precised Arnaldo casiro, head of infectology at Álvarez hospital, “the role of these immunomodulators is to help slow down the inflammatory autoimmune response which is triggered in some Covid patients. In this specific case, they help the body regulate the production of a cytokine called interleuquine 6, or IL-6“.

For those who remember that of the “cytokine storm“(now renamed Multisystem inflammatory syndrome), IL-6 plays an important role. “When it is within normal values, it helps fight pathogens. But its overproduction generates inflammatory effects,” added the doctor.

As in rheumatoid arthritis (the condition for which tocilizumab and sarilumab are commonly used), Covid can lead to a condition typical of autoimmune diseases, and that is the body tries against itself.

It is that, recalled Casiró, “Covid has two stages: the first is infectious, when the virus reproduces in the body. The second and most serious occurs in cases where the inflammatory phase is triggered. All the images that lead to a ventilator, dialysis or any other serious condition have to do with this inflammatory condition ”.

“The standard treatment so far is the corticosteroid dexamethasone, an anti-inflammatory which, it should be noted, must be administered at the time of inflammation and not before. We see people who self-heal with corticosteroids as soon as they start to cough, which can be very harmful, ”he warned.

The figures

The WHO statement emphasizes that “the risk of dying within 28 days is lower in patients who have received antagonists of interleukin-6. In this group, the risk of death was 22%, against an assumed risk of 25% in those who received only the usual care ”.

He then notes “improvements in patients who had also received corticosteroids. For them, the risk of dying in 28 days was 21% – for patients who received interlequin-6 antagonists, against 25% assumed for patients who received usual care ”.

In other words, “out of 100 of these patients, 4 more will survive.” But the relationship goes from 100 to 7 If patients are seen on edge, they need assisted mechanical ventilation. With the aforementioned drugs, the risk of death of 33% remains, for them, at 26%, underlines the WHO, and summarizes what they saw “advantages and no effect and harm”.

Perspectives

In Argentina, therapy with these drugs is being tested by research teams from different hospitals. Pirovano Hospital is one such institution.

As explained at Clarin Ricardo Teijeiro, in charge of infectology at this hospital, “the research sector uses tocilizumab. Depending on the table, processing may take between five and ten days.

Although he clarified that “the results in some patients were buenos“, He preferred to sketch a sober and careful comment. On the one hand, because of the side effects that these drugs can generate for him. But also because “these therapies are not indicated for any patient“.

Amid the desperation of having a serious family member, do many people turn to doctors to demand to try this or that treatment, which they have learned from the media, he said. declared.

“It happens with hyperimmune equine serum, with convalescent plasma, antivirals… each treatment must be assessed by the responsible physician based on the patient’s file and history“, He said.

And he summed up: “Dexamethasone continues to be the primary treatment. Now from what we see, none of these other treatments produce radically different results. We test them. We are on a fine line when it comes to making these decisions. I cannot generalize “.

PS