Coronavirus can set off immune system 'storm'; these drugs may calm it | via nytimes COVID19
Many coronavirus patients seem to get better at first, then rapidly decline and are overtaken by an overwhelming immune response that causes the body to turn on itself.
When immune cells first encounter a pathogen, they release molecules called cytokines to recruit even more cells to the fight. Once the danger recedes, the immune system usually turns itself off. But occasionally “it doesn’t shut up,” said Dr. Jose Scher, a rheumatologist at New York University Langone Health. “The immune system goes on and on and on and on.”
Anecdotal evidence and preliminary trials soon confirmed their hunch. Since then, several studies have shown that high levels of IL-6 portend respiratory failure and death, and that Actemra lowers these risks. Treating patients with drugs like tocilizumab is “like cutting the branches off a tree,” said Dr. Louis Staudt, a scientist at the National Cancer Institute who was one of the lead investigators of the study. “Acalabrutinib is going for the trunk of the tree.”
“These patients get in trouble because their house is on fire in their lungs,” Dr. Staudt said. “This drug can put out this inflammatory fire by disabling macrophages.” The pandemic has also popularized an approach that is commonplace for treating some diseases, but has not been proved in clinical trials to work for coronavirus patients.
But “in a life-threatening illness when you have a cytokine storm,” Chan said, “it’s more or less a race to remove what will kill you versus the temporary inconvenience of removing things that your body manufactures all the time anyway.”
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