Taipei Veterans General Hospital yesterday said that an elderly woman with a severe case of COVID-19 had been successfully treated with a biological agent normally used for rheumatoid arthritis.
Division of Allergy, Immunology and Rheumatology director Tsai Chang-youh (蔡長祐) said that the woman, who was in a critical condition, had been transferred to the hospital in March.
The patient had difficulty breathing and serious pulmonary edema, so she was put on a ventilator and given extracorporeal membrane oxygenation (ECMO), Tsai said.
In a chest radiograph her lungs were completely whited out, which meant her condition was life-threatening, he said.
After discussing her case in several meetings and gaining the hospital’s approval, his medical team administered an interleukin-6 (IL-6) inhibitor to fight a cytokine storm that was causing the edema.
A cytokine storm is a severe immune reaction in which excessive amounts of pro-inflammatory molecules are produced. This flood of molecules attacks cells and tissue rather than just fighting off a virus.
People with COVID-19 sometimes have the same condition as people with rheumatic autoimmune diseases, in which the immune system mistakenly attacks healthy cells, causing inflammation throughout the body, Tsai said.
Liao Hsieh-tsung (廖顯宗), an attending physician in the division, said that the woman was given antibiotics and vasopressor agents for more than two weeks, but her condition did not improve much.
The team discussed whether her cardiopulmonary function and blood pressure were being affected by the cytokine storm and what alternatives might be more effective, Liao said, adding that they believed the IL-6 inhibitor would likely be the most effective treatment.
A day after administering the inhibitor, a chest radiograph showed that her lungs had improved significantly, Liao said, adding that she was taken off the ventilator and ECMO less than three weeks later.
Pneumonia caused by COVID-19 or other factors can lead to increased levels of cytokines, including IL-6, and the lung condition can be improved if IL-6 is inhibited, Tsai said, adding that when they made the decision to administer the inhibitor, they had not heard of other countries using the same method to treat people with COVID-19 in a similar condition.
Inflammation is often the cause of death in patients with viral infections, he said, adding that the IL-6 inhibitor controlled the inflammation, but did not fight the virus itself.
The inhibitor is covered by the National Health Insurance when prescribed to people with rheumatoid arthritis and it must be approved as a special case, Tsai said.
The Central Epidemic Command Center has included the drug in its Interim Guidelines for Clinical Management of SARS-CoV-2 Infection, Tsai said.
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