Eur J Hosp Pharm: first published as 10.1136/ejhpharm-2021-002694 on 4 February 2021. Downloaded from Letter Haematology patients infected colleagues,1 who said that siltuximab 4Department of Genetics, Ion Chiricuta Oncology might be a viable option in the treatment Institute, Cluj Napoca, Romania with SARS-CoV -2, pretreated with of SARS-CoV -2, by suggesting that drugs Correspondence to Dr Ciprian Tomuleasa, Iuliu eculizumab or siltuximab, develop that induce a similar biological effect Hagieganu University of Medicine and Pharmacy Faculty of Medicine, Cluj Napoca 400124, Romania; could have similar therapeutic applica- oligosymptomatic disease ciprian.tomuleasa@ umfcluj.ro tions. More specifically, we would like to propose that drugs inducing a reduction Funding The authors have not declared a specific We have read with great interest the in immune activity might be candidates grant for this research from any funding agency in the publication from Palanques-Pastor and for ameliorating severe SARS-CoV -2 public, commercial or not-for-profit sectors. 1 colleagues, and due to the interest in this infection. Competing interests None declared. subject we would like to mention that we In this regard we would like to mention Patient consent for publication Not required. also observed no SARS-CoV -2 symptoms two patients from our clinic diagnosed Provenance and peer review Not commissioned; in a patient with multicentric Castleman’s with paroxysmal nocturnal haemoglo- internally peer reviewed. disease. The patient was a woman diag- binuria and treated with eculizumab. This article is made freely available for use in nosed in her 20s, who initially presented Both of these patients were infected with accordance with BMJ’s website terms and conditions with sweating, fatigue, dyspnoea at SARS-CoV -2 but presented no symptoms. for the duration of the covid-19 pandemic or until medium effort and weight gain. At the The lack of symptoms in these patients otherwise determined by BMJ. You may use, download clinical exam, the only concerning obser- might also be caused by the mechanism of and print the article for any lawful, non-commercial purpose (including text and data mining) provided that vation was that the patient presented with action of eculizumab because it binds to all copyright notices and trade marks are retained. abdominal obesity. Aside from this, the the C5 fraction of complement, inhibiting © European Association of Hospital Pharmacists 2021. patient had normal respiratory, cardiac the complement pathway, thus reducing No commercial re-use. See rights and permissions. and digestive examinations. She was inflammatory signalling and the effects Published by BMJ. 6 negative for the following viruses: HIV, that SARS-CoV -2 would induce. More human herpesvirus 8, hepatitis B virus curiously, we have to mention that of all and hepatitis C virus, and received four the patients infected with SARS-CoV -2 in our department, only one died of To cite Iluta S, Pasca S, Dima D, et al. Eur J Hosp Pharm cycles of anti-interleukin-6 (IL-6) therapy Epub ahead of print: [please include Day Month Year]. with siltuximab. She later tested positive SARS-CoV -2 while the remainder had doi:10.1136/ejhpharm-2021-002694 for SARS-CoV-2 at a routine screening, mild symptoms. Because most treatments but had no symptoms. The patient was in haematology generate a certain level of Eur J Hosp Pharm 2021;0:1. asymptomatic throughout the period of immunosuppression and because haema- doi:10.1136/ejhpharm-2021-002694 tological disorders are frequently asso- time she was positive. We assume that the ORCID iD siltuximab treatment helped in the lack ciated with immune suppression, these Ciprian Tomuleasa http://orcid. org/0000- 0001-5500- of symptoms when she was infected with factors might add to our argument that 1519 SARS-CoV-2. This was possible because there are cases in which there are equiva- SARS-CoV-2 leads to cytokine release and lent therapeutic strategies to obtaining the REFERENCES determines the formation of an important same effect. This observation is important 1 Palanques-Pastor T, López-Briz E, Poveda Andrés JL. proinflammatory environment.2 This because it could offer an additional factor Involvement of interleukin 6 in SARS-CoV-2 infection: siltuximab as a therapeutic option against COVID-19. for consideration when assessing the prob- http://ejhp.bmj.com/ has been observed in studies and current Eur J Hosp Pharm 2020;27:297–8. guidelines because SARS-CoV -2 infection ability of a patient developing the severe 2 Mehta P, McAuley DF, Brown M, et al. COVID-19: is associated with an increase in blood form of SARS-CoV -2. Moreover, drugs consider cytokine storm syndromes and IL-6, with patients with severe disease could be repurposed that might be useful immunosuppression. Lancet 2020;395:1033–4. 3 in the treatment of this viral infection. 3 Samaee H, Mohsenzadegan M, Ala S, et al. Tocilizumab benefiting from tocilizumab treatment. for treatment patients with COVID-19: recommended Tocilizumab acts by binding both to the Sabina Iluta,1 Sergiu Pasca,2 Delia Dima,3 medication for novel disease. Int Immunopharmacol soluble and membrane bound forms of Gabriela Mester,3 Laura Urian,1 Anca Bojan,1 2020;89:107018. the IL-6 receptor, thus inhibiting IL-6 Mihnea Zdrenghea,1 Adrian Trifa,1 4 Sebba A. Tocilizumab: the first interleukin-6-receptor on September 26, 2021 by guest. Protected copyright. inhibitor. Am J Health Syst Pharm 2008;65:1413–8. signalling and the inflammatory response Ovidiu Balacescu,4 Ciprian Tomuleasa 1,2 4 5 Sarosiek S, Shah R, Munshi NC. Review of siltuximab in to SARS-CoV-2. Siltuximab also inhibits 1Department of Hematology, Iuliu Hatieganu University the treatment of multicentric Castleman’s disease. Ther IL-6 signalling, but by directly forming of Medicine and Pharmacy, Cluj Napoca, Romania Adv Hematol 2016;7:360–6. 2 complexes with IL-6, thus blocking its Medfuture Research Center for Advanced Medicine, 6 Wijnsma KL, Ter Heine R, Moes DJAR, Iuliu HaTieganu University of Medicine and Pharmacy action on the IL-6 receptor.5 Because of et al. Pharmacology, pharmacokinetics and Faculty of Medicine, Cluj Napoca, Romania pharmacodynamics of eculizumab, and possibilities this observation we would like to add 3Department of Hematology, Ion Chiricuta Oncology for an individualized approach to eculizumab. Clin to the article by Palanques-Pastor and Institute, Cluj Napoca, Romania Pharmacokinet 2019;58:859–74.
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