CHICAGO — Some patients with the novel coronavirus suffer a severe immune response that triggers potentially fatal hyperinflammation, studies have shown. The reaction, named for the body’s proteins that attack lung tissue, is known as a “cytokine storm.”
“A storm is a good way to describe it,” Northwestern Medicine’s Dr. Richard Wunderink said. “It can cause acute respiratory distress syndrome, … essentially flooding the lungs.”
In response, researchers like Wunderink are racing to see if they can find a way to prevent such a catastrophic chain of events. Northwestern Medicine in Chicago is testing a drug called sarilumab, which is otherwise used to reduce inflammation in rheumatoid arthritis.
As medical director of the intensive care unit, Wunderink and his colleagues have helped treat more than 100 patients on mechanical ventilation. Early results elsewhere show that many patients do not do well on ventilators, and the drug treatment is an attempt to avoid that last resort.
“We have no therapy for COVID-19, per se,” Wunderink explained. “We are managing these patients using what research has shown is the best management for acute respiratory distress syndrome, so that’s the best we have to offer.”
The research is part of a global clinical trial of more than 1,000 patients sponsored by the drug’s maker, Regeneron Pharmaceuticals.
The drug is being given to patients with very severe COVID-19 infection who have a high chance of dying or prolonged critical care.
Sarilumab works by blocking an inflammatory cytokine the body makes called interleukin-6.
The randomized, double-blind trial will give 80% of the patients the drug, and 20% an inactive placebo, to test the reaction.
To enter the trial, patients must be hospitalized with laboratory-confirmed COVID-19 that is classified as severe or critical, or who are suffering from multi-organ dysfunction. All patients must have pneumonia and fever.
Because the drug blocks part of the immune response, patients will be tested to guard against them developing any other infections or other side effects.
“We think this will block a fair amount of the inflammation,” Wunderink said. “I think we will have answers before the end of this pandemic.”
Preliminary phase 2 results checking for a measurement of inflammation called C-reactive protein should be back by the end of April, a Regeneron spokeswoman said. Later results will look for reductions in ventilator use and death.
“The best strategy right now is prevention,” adds Dr. Wunderink. “We want to thank those who are making important sacrifices by social distancing, so we can provide the best care to those in our community who become the most ill.”
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