EULAR: Tocilizumab plus glucocorticoids benefits COVID-19 cases requiring oxygen
Click Here to Manage Email Alerts
Tocilizumab plus glucocorticoids is beneficial for patients with COVID-19 who require oxygen therapy, according to updated EULAR “points to consider” on the use of immunomodulatory therapies in SARS-CoV-2.
The 2021 update also states that anti-SARS-CoV-2 monoclonal antibodies and convalescent plasma may be useful in early phases of the disease and in certain immunosuppressed patients.
“The use of immunomodulatory therapies in SARS-CoV-2 infection is a rapidly evolving field and it represents a challenge for the scientific community,” Xavier Mariette, MD, PhD of the University of Paris-Saclay, in France, and colleagues wrote in Annals of the Rheumatic Diseases. “New evidence informing best practice for clinical management of patients infected with SARS-CoV-2 and presenting with COVID-19 are released on a weekly basis, leading to the continuous need for updated policies in the field.
“In this context, several scientific societies, including EULAR, have formulated guidance on treatment of COVID-19,” they added. “In order to propose the most up-to-date treatment strategies to physicians and patients, efforts to update these recommendations in a timely manner must be undertaken.”
To update the EULAR points to consider on the use of immunomodulatory therapies in COVID-19, Mariette and colleagues reconvened the same multidisciplinary task force that developed the first version. Two clinicians performed an updated systematic literature review of studies on COVID-19 management with immunomodulatory therapies published between Dec. 11, 2020, and July 14, 2021.
The task force later reviewed the updated findings in a consensus meeting. Updates to the points to consider were approved through two rounds of voting.
The 12 new points to consider approved by the task force modifies four of the previous points and adds four new ones. The two overarching principles and four of the original points remain unchanged.
Among the changes, the task force stated that glucocorticoids, alone or in combination with tocilizumab (Actemra, Genentech) are beneficial in patients with COVID-19 who need oxygen therapy, as well as in critical COVID-19 cases. In addition, JAK inhibitors such as baricitinib (Olumiant, Eli Lilly & Co.) and tofacitinib (Xeljanz, Pfizer) are “promising” in those with severe and critical COVID-19. The task force also stated that anti-SARS-CoV-2 monoclonal antibodies and convalescent plasma may be useful in early phases of COVID-19 and in selected subgroups of immunosuppressed patients.
Meanwhile, the task force found insufficient evidence for the efficacy of other immunomodulators, with further work required on biomarker-based stratification for IL-1 therapy.
“Three types of immunomodulators have demonstrated efficacy for preventing death in severe and critical COVID are corticosteroids, anti-IL-6 receptors Ab and JAK inhibitors,” Mariette told Healio Rheumatology. “It is a new paradigm: For 20 years we have been afraid of a risk of infections with immunomodulators. In this case, they are indicated for treating a serious infection. Thus, rheumatologists have to continue to be involved in COVID pathophysiological and clinical research.”
Collapse
Read more about
Click Here to Manage Email Alerts