ABSTRACT

Introduction: The coronavirus disease 2019 (COVID-19) pandemic, caused by a newly discovered coronavirus (severe acute respiratory syndrome coronavirus 2, or SARS-CoV-2), continues to spread all around the world. Despite the emergency of COVID-19 worldwide, remdesivir is the only treatment that has been recently approved to treat the diseases, and other effective therapies are still lacking. SARS-CoV-2 may cause severe illness in 20% of patients. Based on available data, there is an association between interleukin-6 (IL-6) and severe COVID-19. Sarilumab is a fully human immunoglobulin G1 monoclonal antibody binding to both membrane-bound and soluble IL-6 receptors with high affinity and has been considered for off-label use in the treatment of COVID-19.

Areas covered: The present article reviews recently published literature focusing on the pathophysiology of COVID‐19 induced cytokine storm, the potential therapeutic role, and important clinical issues of sarilumab in the treatment of COVID‐19 patients.

Expert opinion: The off-label treatment administration is unavoidable in the critical situation of the COVID-19 pandemic. Further efforts should be directed to determine mechanisms of SARS-CoV-2 induced immune dysregulation as well as indications of sarilumab in the patients with COVID-19 to minimize concerns regarding its off-label administration.

摘要

简介：由新发现的冠状病毒（严重急性呼吸系统综合症冠状病毒2或SARS-CoV-2）引起的2019年冠状病毒病（COVID-19）大流行继续在世界各地蔓延。尽管全球范围内发生COVID-19的紧急情况，但雷姆昔韦是最近被批准用于治疗该疾病的唯一疗法，并且仍然缺乏其他有效的疗法。SARS-CoV-2可能在20％的患者中引起严重疾病。根据现有数据，白介素6（IL-6）与严重COVID-19之间存在关联。Sarilumab是一种完全人免疫球蛋白G1单克隆抗体，它以高亲和力与膜结合和可溶性IL-6受体结合，已被认为可用于COVID-19的脱标签治疗。

涵盖的领域：本文回顾了最近发表的文献，重点关注COVID-19诱导的细胞因子风暴的病理生理学，sarilumab在治疗COVID-19患者中的潜在治疗作用以及重要的临床问题。

专家意见：在COVID-19大流行的危急情况下，不可避免地要进行标签外治疗。应该进一步努力确定SARS-CoV-2诱导的免疫失调的机制以及COVID-19患者的sarilumab适应症，以最大程度地减少对非标记给药的担忧。