{"id":38378,"date":"2020-07-22T07:23:30","date_gmt":"2020-07-22T07:23:30","guid":{"rendered":"http:\/\/i-base.info\/htb\/?p=38378"},"modified":"2020-07-23T17:54:57","modified_gmt":"2020-07-23T17:54:57","slug":"individualising-management-of-covid-19-based-on-real-time-inflammatory-responses","status":"publish","type":"post","link":"https:\/\/i-base.info\/htb\/38378","title":{"rendered":"Individualising management of COVID-19 based on real-time inflammatory responses"},"content":{"rendered":"<p class=\"HTBBODYtext\"><strong><span lang=\"EN-US\"><b><img loading=\"lazy\" decoding=\"async\" class=\" alignright\" src=\"https:\/\/i-base.info\/wp-content\/uploads\/2020\/03\/COVID-19-graphic.png\" width=\"231\" height=\"142\" \/><\/b>Simon Collins, HIV i-Base<\/span><\/strong><\/p>\n<p class=\"HTBBODYtext\"><strong><span lang=\"EN-US\">An open-access paper in CID proposes further individualising management of COVID-19 to include choice of treatment to reduce immune inflammation and anti-cytokine treatment in selected patients. Current studies, for example using the IL-6 blocker tocilizumab, are used as COVID-19 treatment without entry criteria that include baseline markers.<\/span><\/strong><\/p>\n<p class=\"HTBBODYtext\"><span lang=\"EN-US\">For example, the inflammatory response &#8211; the cytokine storm &#8211; in progressing COVID-19 has been compared to conditions that include classical acute respiratory distress syndrome (ARDS), macrophage activation syndrome (MAS) or hemophagocytic lymphohistiocytosis (HLH), but that is likely different to all of these.<\/span><\/p>\n<p class=\"HTBBODYtext\"><span lang=\"EN-US\">The paper describes current understanding of immune responses to COVID-19 and highlights a range of therapeutic responses that might help, although with a caution that treating these symptoms might still not improve clinical responses. For example, <\/span>prostaglandin E1, ketoconazole and GM-CSF have not been effective with ARDS (in studies that did not individualise immune profiles of participants).<\/p>\n<p class=\"HTBBODYtext\"><span lang=\"EN-US\">The paper suggests that drugs like tocilizumab or anakinra might only be appropriate in a subset of patients with the most severe elevations in systemic pro-inflammatory cytokines (e.g. IL-6 levels &gt;1,000 pg\/mL).<\/span><\/p>\n<p class=\"HTBBODYtext\"><span lang=\"EN-US\">It also suggests that treatment should be guided by real-time changes in the immunophenotype and using short-acting drugs so that protocols can adapt to the dynamic nature of immune response over time.<\/span><\/p>\n<p class=\"HTBBODYtext\"><span lang=\"EN-US\">The paper concludes that management of immune modulation in COVID-19 has wide inter-patient variability and should adapt to the dynamic nature of the individual pathogenesis and related immune response.<\/span><\/p>\n<p class=\"HTBreference-noindent\"><span lang=\"EN-US\">References<\/span><\/p>\n<p class=\"HTBreference-noindent\"><span lang=\"EN-US\">Hall MW et al. <\/span><span lang=\"EN-US\">Immune modulation in COVID-19: Strategic considerations for personalized therapeutic intervention<\/span><span lang=\"EN-US\">. Clinical Infectious Diseases, ciaa904, DOI: 10.1093\/cid\/ciaa904. (01 July 2020).<br \/>\n<\/span><a href=\"https:\/\/academic.oup.com\/cid\/article\/doi\/10.1093\/cid\/ciaa904\/5865455\" rel=\"noopener noreferrer\"><span lang=\"EN-US\">https:\/\/academic.oup.com\/cid\/article\/doi\/10.1093\/cid\/ciaa904\/5865455<\/span><\/a><\/p>\n<p><em>This report was first published on 5 July 2020.<\/em><\/p>\n","protected":false},"excerpt":{"rendered":"<p>Simon Collins, HIV i-Base An open-access paper in CID proposes further individualising management of COVID-19 to include choice of treatment to reduce immune inflammation and anti-cytokine treatment in selected patients. Current studies, for example using the IL-6 blocker tocilizumab, are &hellip;<\/p>\n","protected":false},"author":3,"featured_media":0,"comment_status":"open","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[283,278],"tags":[],"class_list":["post-38378","post","type-post","status-publish","format-standard","hentry","category-covid-19-investigational-drugs","category-covid-19"],"_links":{"self":[{"href":"https:\/\/i-base.info\/htb\/wp-json\/wp\/v2\/posts\/38378","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/i-base.info\/htb\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/i-base.info\/htb\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/i-base.info\/htb\/wp-json\/wp\/v2\/users\/3"}],"replies":[{"embeddable":true,"href":"https:\/\/i-base.info\/htb\/wp-json\/wp\/v2\/comments?post=38378"}],"version-history":[{"count":0,"href":"https:\/\/i-base.info\/htb\/wp-json\/wp\/v2\/posts\/38378\/revisions"}],"wp:attachment":[{"href":"https:\/\/i-base.info\/htb\/wp-json\/wp\/v2\/media?parent=38378"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/i-base.info\/htb\/wp-json\/wp\/v2\/categories?post=38378"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/i-base.info\/htb\/wp-json\/wp\/v2\/tags?post=38378"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}