Baricitinib as rescue therapy in a patient with COVID-19 with no complete response to sarilumab
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Baricitinib as rescue therapy in a patient with COVID‑19 with no complete response to sarilumab A. Cingolani1,2 · A. M. Tummolo3,8 · G. Montemurro4 · E. Gremese4,5 · L. Larosa6 · M. C. Cipriani3 · G. Pasciuto4 · R. Liperoti3,5 · R. Murri1,2 · T. Pirronti6,7 · R. Cauda1,2 · M. Fantoni1,2 · for COVID 2 Columbus Working Group Received: 30 May 2020 / Accepted: 28 June 2020 © Springer-Verlag GmbH Germany, part of Springer Nature 2020
Abstract A patient with COVID-19-related severe respiratory failure, with insufficient response to an antiretroviral therapy, hydroxychloroquine and Interleukin-6 (IL-6) antagonist therapy, presented a prompt resolution of the respiratory function and improvement in the radiological picture after baricitinib at an oral dose of 4 mg per day for 2 weeks. Keywords Baricitinib · SARS-CoV-2 · Sarilumab · COVID-19 · Immunotherapy
Introduction In January 2020, the World Health Organization declared the outbreak of a global health emergency due to coronavirus disease 2019 (COVID-19). It started in Wuhan, China, in December 2019 [1]. Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is a novel coronavirus that is able to infect humans. It binds to angiotensin-converting enzyme 2 (ACE2) receptors that are highly expressed on the cell surface of multiple organs. The main pathogenetic mechanisms * A. M. Tummolo [email protected] 1
Dipartimento di Scienze di Laboratorio e Infettivologiche, Fondazione Policlinico Gemelli IRCCS, Rome, Italy
2
Dipartimento di Sicurezza e Bioetica, Università Cattolica S. Cuore, Milan, Italy
3
Dipartimento di Scienze dell’invecchiamento, Fondazione Policlinico Gemelli IRCCS, Rome, Italy
4
Dipartimento di Scienze Mediche e Chirurgiche, Fondazione Policlinico Gemelli IRCCS, Rome, Italy
5
Dipartimento di Scienze Geriatriche e Ortopediche, Università Cattolica S. Cuore, Milan, Italy
6
Dipartimento di Diagnostica per immagini, Fondazione Policlinico Gemelli IRCCS, Rome, Italy
7
Dipartimento di Scienze Radiologiche e Ematologiche, Università Cattolica S. Cuore, Milan, Italy
8
Division of Infectious Diseases, Covid 2 Columbus, Fondazione Policlinico Gemelli, IRCCS, Università Cattolica S. Cuore, L.go A. Gemelli 8, 00167 Rome, Italy
are represented by cytokine storm, characterized by high levels of pro-inflammatory cytokines, and by the coronavirus immune evasion. Higher plasma levels of cytokines IL-6, IL-2, IL-7, IL-10, interferon gamma inducible protein (IP10), monocyte chemoattractant protein (MCP1), macrophage inflammatory protein (MIP1A) and TNF-alpha have been found in COVID-19 patients admitted to intensive care units, and the cytokine storm syndrome was proportional to the severity of disease [2, 3]. Recently, Infectious Diseases Society of America (IDSA) guidelines pointed out the lack of evidence in the efficacy of any pharmacological approach for COVID-19, strongly suggesting the inclusion of patients in clinical trials [4]. Among these drugs, anti-IL6 receptor (id est tocilizumab) [5] has been adopted to treat
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