Cassandra Calabrese, DO, and Leonard H. Calabrese, DO will provide weekly newsletter articles focused on COVID-19.
Let us introduce you to a great resource in the form of the Cleveland Clinic Journal of Medicine’s COVID-19 Curbside Consults. This is the brainchild of Brian Mandell MD PhD, editor in chief of CCJM, who is both our dear friend and colleague and noted educational innovator. Even more of note is the section edited Kristin Hyland MD, who is a boarded in both Pulmonology Critical Care Medicine and Rheumatology, which give the section a true RHEUM vantage point. https://www.ccjm.org/content/covid-19-curbside-consults
These articles are designed to be brief, to the point, and to address specific issues. We invite you to peruse the entire list but we will highlight a few pieces today.
Practical aspects of targeting IL-6 in COVID-19 disease, April 21, 2020. By Cassandra Calabrese, DO; Prabalini Rajendram, MD; Gretchen Sacha, PharmD; and Leonard Calabrese, DO
Comment: There are over a 100 agents currently in clinical trials to treat COVID-19 and many are targeting immune activation. Among the hottest targets is IL-6 and since this piece was written way back about 3 weeks ago some early data is already coming out regarding the multicenter international trials of tocilizumab and sariluamb. Please note there are also numerous other either direct or indirect inhibitors of IL-6 (siltuximab, clazakizumab, etc.). This article is a practical approach to the clinical and pharmacokinetic considerations of IL-6 targeting in cytokine release syndrome in COVID-19.
Cytokine storm and the Prospects for Immunotherapy with COVID-19, April 13, 2020. By Leonard Calabrese, DO
Comment: While there are many gaping holes in our understanding of COVID-19, what is clear is that the patients are not dying from a direct viral infection, but rather from collateral damage from a heightened immune response, or “cytokine storm.” This piece nicely outlines the stages of COVID-19 infection, focusing on the 3rd and most-feared stage of severe respiratory symptoms and hyper-inflammatory state. Prevention of this stage is the focus of most of the targeted therapies being considered for treatment, with enrollment criteria for most being oxygen requirements but not needing a ventilator. While we have learned that rising inflammatory markers (CRP, ferritin, D-dimer, IL-6, etc) likely predict this severe phase of the disease, we do not yet know exactly how to identify these patients nor what is the optimal time to be administering these targeted therapies. The Cleveland Clinic has created a clinical registry, with currently over 2000 COVID-19 positive patients, as well as a bio-repository, with over 200 submissions for data use already. We anxiously await data that will provide answers to our many questions.
Finally, we both hope you are regular readers of Healio Rheumatology and if you haven’t read it please read our joint editorial on what COVID-19 has meant to the both of us both professionally and personally. We would love your take!
Leonard H. Calabrese, DO, is the head of the RJ Fasenmyer Center for Clinical Immunology and Vice-Chair of the Department of Rheumatic and Immunologic Diseases at Cleveland Clinic Dr. Calabrese has lectured nationally and internationally on the subjects of immunology, rheumatology and viral diseases. He is the author of more than 400 published peer-reviewed articles, book chapters, and reviews.
Cassandra Calabrese, DO, is a staff physician in the Department of Rheumatic and Immunologic Diseases and the Department of Infectious Diseases at Cleveland Clinic and directs the combined Rheumatology-Infectious Disease training program. She also directs the Clinic for immune-related adverse events form cancer immunotherapy within the department of Rheumatic and Immunologic Diseases.