Role of Dupilumab in Approved Indications of COVID-19 Patient: an Efficacy-Based Nonsystematic Critical Analysis
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COVID-19
Role of Dupilumab in Approved Indications of COVID-19 Patient: an Efficacy-Based Nonsystematic Critical Analysis Pugazhenthan Thangaraju 1
&
Nanditha Venkatesan 2 & T. Y. Sree Sudha 1 & Sajitha Venkatesan 3 & Eswaran Thangaraju 4
Accepted: 7 September 2020 # Springer Nature Switzerland AG 2020
Abstract With many drugs being tried in the management and treatment of COVID-19, dupilumab is one such monoclonal antibody that has come under the limelight for its possible role as an adjunct therapy in COVID-19 position. There are isolated case reports and series that document a milder course of COVID-19 infection in patients who have already been on dupilumab therapy for treatment of conditions such as atopic dermatitis and chronic rhino-sinusitis with nasal polyp. There is also an ongoing debate regarding the continuation of biologicals in the COVID patient. In this article, a non-systematic critical analysis of dupilumab was performed to delve into this hypothesis further. Keywords Dupilumab . Monoclonal antibody . Chronic rhino-sinusitis with nasal polyp . Atopic dermatitis . COVID-19
Introduction Dupilumab is a human monoclonal IgG4 antibody which binds to the alpha subunit of IL-4, 13 receptors and promotes signaling after binding to the IL-4Rα subunit. While it has already been in use in dermatology clinics for the treatment of atopic dermatitis (AD), it was most recently approved for the indication of chronic rhinosinusitis with nasal polyp (CRSwNP) by the US Food and Drug Association (FDA) on the 26th of June, 2019 [1]. The pathophysiology explored in AD and CRSwNP and the role of the above monoclonal antibodies in link with virus are shown in Fig. 1. A significant anti-viral role of cells, namely, CD4+ T (production of essential specific This article is part of the Topical Collection on COVID-19 * Pugazhenthan Thangaraju [email protected] 1
Department of Pharmacology, All India Institute of Medical Sciences (AIIMS) Raipur, Raipur, Chhatisgarh, India
2
All India Institute of Medical Sciences (AIIMS) Raipur, Raipur, Chhatisgarh, India
3
Department Of Microbiology, All India Institute of Medical Sciences (AIIMS) Raipur, Raipur, Chhatisgarh, India
4
AKT memorial college of engineering and technology, Kallakurichi, Tamil Nadu, India
antibodies) and CD8+ T (cytotoxic toward virus infected cells), plays a very important in balancing against the infection of SARS-CoV-2 and associated inflammation. In addition, there is major trigger for differentiation of T cells into T-helper 1 (Th1) and Th17 in series to the massive release of pro-inflammatory cytokines, namely, tumor necrosis factor (tnf β), interleukin (IL) (1, 6, 8, and 21), and monocytes chemoattractant protein-1 (MCP1) by the viral infection. So these lead to the cytokine storm that will prevent the activation of CD8+ T cells. The corona virus also seems to stimulate the secretion of IL-4 and IL10 (Th-2 cytokines). This in turn suppresses the inflammation mediated by T helper cell (1/17). But dupilumab inhibits the function of IL-4 and IL-
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