Abstract

Objective: This study aims to describe the clinical results of a miniseries of 6 patients who presented characteristic COVID-19 symptoms and PCR positive, who were administered Etanercept, to avoid Cytokine release syndrome with the purpose of decreasing admission to the critical care unit.

Design: This is a prospective, descriptive observational study.

Patients and Methods: 6 patients with (SARS-CoV-2) COVID-19 symptoms were evaluated for the administration of the immunomodulator Etanercept 50 mg. Two groups were aligned: A) Mild: with fever, cough, images compatible with pneumonia, and gastrointestinal symptoms; B) Moderate: with fever, cough, images compatible with pneumonia, gastrointestinal symptoms and respiratory distress considered as L phenotype.

Results: A total of 13 patients were identified with suspected infection of the virus (SARS-CoV-2) COVID-19, from which 6 patients accepted the administration of the immunomodulator Etanercept 50 mg (subcutaneous) in a single dose and protocol follow-up. From these 6 patients: 4 patients had fever, cough, headache and risk factors such as pregnancy and obesity; and 2 patients also presented respiratory distress considered as L phenotype. All 6 evolved to improvement.

No patient was admitted to the critical intensive care unit and did not require invasive ventilatory support.

Conclusion: In this miniseries, the administration of the Etanercept immunomodulator in patients with (SARS-CoV-2) from mild to moderate stage, improved the clinical evolution and reduced the risk of admission to the intensive care unit. However, more patients and more controlled and randomized studies are necessary to recommend immunomodulators.

Keywords: COVID-19; Acute Respiratory Distress Syndrome (ARDS); Cytokine Storm; Inflammation; Anti-Inflammatory, Self-Induced Lung Damage (DPA); Tumor Necrosis Factor (TNF)

References

1. Zhu N., et al. “A Novel Coronavirus from Patients with Pneumonia in China, 2019”. The New England Journal of Medicine (2020).
2. Zhou P., et al. “A pneumonia outbreak associated with a new coronavirus of probable bat origin”. Nature 579 (2020): 270.
3. Kalil A., et al. “Treating COVID-19—Off-Label Drug Use, Compassionate Use, and Randomized Clinical Trials During Pandemics”. JAMA (2020).
4. Jennifer R., et al. “Into the Eye of the Cytokine Storm”. Microbiology and Molecular Biology Reviews (2012).
5. Adurrahman T., et al. “COVID-19, immune system response, hyperinflammation and repurposing antirheumatic drugs”. Turkish Journal of Medical Sciences 50 (2020): 620-632.
6. Yuen KY., et al. “Human infection by avian influenza A H5N1”. Hong Kong Medical Journal 11 (2005): 189-199.
7. Ennio G., et al. “COVID-19 infection and rheumatoid arthritis: Faraway, so close!”. Autoimmunity Reviews 19 (2020) 102523.
8. Picchianti D., et al. “Review Cytokine Release Syndrome in COVID-19 Patients, A New Scenario for an Old Concern: The Fragile Balance between Infection”. International Journal of Molecular Sciences 9 (2020): 3330.
9. Ben Goffe., et al. “Etanerceptt: an overvie”. Journal of the Academy American of Dermatology 49 (2003).
10. Hussell T., et al. “Openshaw Inhibition of tumor necrosis factor reduces the severity of virus-specific lung immunopathology”. European Journal of Immunology 31 (2001): 2566-2573.
11. Yanik G., et al. “Etanercept (Enbrel) Administration for Idiopathic Pneumonia Syndrome after Allogeneic Hematopoietic Stem Cell Transplantation”. Biology of Blood and Marrow Transplantation 8 (2002): 395-400.
12. Duret PM., et al. “Recovery from COVID-19 in a patient with spondyloarthritis treated with TNF-alpha inhibitor etanercept”. Annals of the Rheumatic Diseases (2020).
13. Mandeep R., et al. “Hydroxychloroquine or chloroquine with or without a macrolide for treatment of COVID-19: a multinational registry análisis”. Lancet (2020).
14. , et al. “Should chloroquine and hydroxychloroquine be used to treat COVID-19? A rapid review”. BJGP Open (2020).
15. , et al. “Initial CT findings and temporal changes in patients with the novel coronavirus pneumonia (2019-nCoV): a study of 63 patients in Wuhan”. European Radiology 30.6 (2020): 3306-3309.
16. Marta C., et al. “Tocilizumab for Treatment of Severe COVID-19 Patients: Preliminary Results from SMAtteo COvid19 REgistry (SMACORE)”. Microorganisms 8 (2020): 695.
17. Zayeta K., et al. “Tocilizumab therapy reduced intensive care unit admissions and/or mortality in COVID-19 patients”. Médecine et Maladies Infectieuses (2020).
18. , et al. “Perspectives of Immune Therapy in Coronavirus Disease 2019”. Journal of Korean Medical Science 35.18 (2020): e176.
19. Joan M., et al. “A comparation of etnercept and methotrexate in patients with early rheumatoid arthritis”. New England Journal of Medicine (2000).

Citation

Citation: Adán Oliveros-Ceballos., et al. “Use of Immunomodulators (Etanercept) in a Miniseries with Covid-19 Patients, to Decrease the Progress of Complications and Risks of Entry into Critical Care. Bibliography Review". Acta Scientific Women's Health 2.8 (2020): 08-18.

Copyright

Copyright: © 2020 Adán Oliveros-Ceballos., et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.