Anti-cytokine treatments in Covid-19 disease: IL-6 receptor inhibitor (Tocilizumab) and IL-1 receptor antagonist (Anakinra)

Abstract

Coronavirus disease 2019 (COVID-19) first appeared in Wuhan, China in December 2019 and has caused a massive global pandemic. It has become an important problem for public health all over the world. Although the majority of those who suffer from the disease have a good prognosis, it causes macrophage activation syndrome (MAS) that affects the lung in some patients. It is known that the rate of cytokine increase and the amount of cytokines play a role in the transition from the expected inflammation response to hyperinflammation in individuals with the disease. Mortality rates are high in the patient group with MAS, and changes in the clinical and laboratory findings of the patient are observed in a short time. Therefore, a dynamic treatment process is needed. Glucocorticoid treatments are recommended, especially in patients who need respiratory support. Anti-cytokine treatments come into question in patients with no glucocorticoid response. It is important to identify the patient group who can benefit from anti-cytokine therapies correctly and on time, in order to plan an effective and safe treatment.

Keywords

• Covid-19
• Tocilizumab
• Anakinra
• cytokine storm

Covid-19 Hastalığında Anti-sitokin Tedaviler: IL-6 Reseptör İnhibitörü (Tosilizumab) ve IL-1 Reseptör Antagonisti (Anakinra)

Abstract

Koronavirüs hastalığı 2019 (COVID-19) ilk kez Aralık 2019 tarihinde Çin'in Wuhan kentinde ortaya çıktı ve büyük bir küresel salgına neden oldu. Tüm dünyada halk sağlığı için önemli bir problem haline geldi. Hastalık geçirenlerin büyük çoğunluğu iyi bir prognoza sahip olmasına rağmen bazı hastalarda özellikle akciğeri etkileyen makrofaj aktivasyonu sendromuna (MAS) neden olmaktadır. Hastalığı geçiren bireylerde beklenen inflamasyon yanıtından hiperinflamasyona geçişte sitokin artış hızı ve sitokin miktarının rolü olduğu bilinmektedir. MAS gelişen hasta grubunda mortalite oranları yüksek seyretmektedir ve hastaların klinik ve laboratuvar bulgularında kısa sürede ortaya çıkan değişiklikler görülmektedir. Bu nedenle dinamik bir tedavi süreci ihtiyacı vardır. Özellikle solunum desteği ihtiyacı olan hastalarda glukokortikoid tedaviler önerilmektedir. Glukokortikoid yanıtı olmayan hastalarda anti-sitokin tedaviler gündeme gelmektedir. Anti-sitokin tedavilerden yararlanabilecek hasta grubunun doğru ve vaktinde tanımlanması, etkili ve güvenli bir tedavi planlanması açısından önem taşımaktadır.

Keywords

• Covid-19
• Tosilizumab
• Anakinra
• sitokin fırtınası

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