Practical aspects of targeting IL-6 in COVID-19 disease.

Calabrese, Cassandra; Rajendram, Prabalini; Sacha, Gretchen; Calabrese, Leonard

Severe cases of COVID-19 are often attended by a syndrome that has been described as "cytokine storm," with some features shared with macrophage activation syndrome. A variety of experimental therapies targeting this hyperinflammatory state are now being applied in hospitals around the world. Among the most widely used treatments are monoclonal antibodies targeting interleukin-6 (IL-6) or the IL-6 receptor. Anti-IL-6 drugs are being widely used experimentally and as off-label therapy for patients with COVID-19 who are sick and deteriorating but have a reasonable chance of recovering, but they are still unproven and unapproved for this use. The pandemic has created major ethical and practical questions about patient selection and nonapproved use vs use in the context of a randomized clinical trial.