Abstract
Use of interleukin (IL-6) inhibitors has become one of the most complicated clinical issues in treating coronavirus disease 2019 (COVID-19). Recently, randomized open-label platform trials have found that IL-6 inhibitors have a beneficial effect on mortality in severe COVID-19. However, several questions arise around their mechanism of action in this disease, as well as how, when, and at which dose they should be used. IL-6 has both proinflammatory and anti-inflammatory effects, which may modulate the course of COVID-19, whose immunopathogenesis is driven by the innate immune system, autoantibodies, and interferon. Given that patients with delayed seroconversion against the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) spike protein would be at the highest risk of complications beyond the second week of disease, we propose that considering patient serostatus at admission could optimize the use of IL-6 inhibitors in COVID-19. We predict that the net treatment benefits could be higher in the subgroup of patients with delayed seroconversion as compared to those who seroconvert more rapidly after SARS-CoV-2 infection.
Keywords: COVID-19; IL-6 inhibition; SARS-CoV-2; therapy; tocilizumab.
【저자키워드】 COVID-19, SARS-CoV-2, therapy, tocilizumab., IL-6 inhibition, 【초록키워드】 Treatment, coronavirus disease, Coronavirus disease 2019, coronavirus, Anti-inflammatory effects, Mortality, Open-label, severe COVID-19, Tocilizumab, IL-6, SARS-COV-2 infection, interferon, risk, severe acute respiratory syndrome Coronavirus, inhibitors, Spike protein, innate immune system, Randomized, proinflammatory, Seroconversion, interleukin, autoantibodies, Immunopathogenesis, Patient, Complication, Platform trial, respiratory, inhibitor, serostatus, mechanism of action, disease, Admission, predict, IL-6 inhibitor, dose, IL-6 inhibitors, acute respiratory syndrome, acute respiratory syndrome coronavirus, acute respiratory syndrome coronavirus 2, seroconvert, benefit, Course, highest, question, modulate, driven by, subgroup of patient, 【제목키워드】 role, time, Against,