Actemra (tocilizumab), a medicine approved for certain types of arthritis, may be effective in treating severe infections with the new coronavirus in people with multiple myeloma or other blood disorders, findings from a patient in China suggest.
The case report also indicates that those with blood cancers may have atypical COVID-19 symptoms, like an absence of fever or cough.
The study, “First case of COVID-19 in a patient with multiple myeloma successfully treated with tocilizumab,” was published in Blood Advances.
People with multiple myeloma are considered to be at risk of severe coronavirus infections due to a weakened immune system. But how COVID-19 manifests in these patients and how to best manage them is unclear.
“What are the characteristics of COVID-19 in patients with blood cancers? What is the optimal treatment approach? Everything is unknown, and that was the motivation for this study,” Changcheng Zheng, MD, the report’s lead author, said in a press release.
Zheng and his team at the University of Science and Technology of China, detailed the case of an individual diagnosed with multiple myeloma in 2015, who was hospitalized with severe pneumonia caused by COVID-19, and whose disease was successfully treated with Actemra.
The 60-year-old man came to a local hospital in Wuhan in early February, complaining of chest tightness and shortness of breath without fever or cough. A computed tomography (CT) imaging scan showed signs of pneumonia, and the patient was immediately admitted. His illness was classified as severe.
He had a history of myeloma and was on maintenance therapy, but his symptoms had disappeared after chemotherapy treatment. At admission, he was given antibiotics; when a SARS-CoV-2 test came back positive, he was switched to antiviral and corticosteroid treatment, which did not fully resolve his symptoms.
In some patients infected with SARS-CoV-2, it is not the virus itself that does the worst damage. Instead, this virus triggers excessive production of immune cells and their inflammatory molecules in a life-threatening reaction known as cytokine storm, which causes severe lung damage and acute respiratory distress.
Researchers worldwide recently discovered that interleukin (IL-6) signaling might be the main culprit of this uncontrolled immune reaction in COVID-19 patients, suggesting that IL-6 inhibitors, such as Genentech‘s Actemra, may effectively control lung damage induced by the virus.
Since the patient had high levels of IL-6, he was treated with Actemra and within three days his chest tightness disappeared. One week later, imaging scans showed markedly lesser lung lesions, and the patient was discharged.
These findings suggest that Actemra may be used to address the severe inflammatory responses triggered by COVID-19, “but further prospective and randomized clinical trials are needed to verify the findings,” Zheng said.
A Phase 3 trial (NCT04320615) is ongoing to evaluate the safety and efficacy of tocilizumab, against standard care, in people hospitalized with severe COVID-19 pneumonia. The trial aims to include 330 adult patients at sites across the U.S., Canada, and Europe. More information is available here.
Zheng also suggests that because the most common symptoms of COVID-19, cough and fever, were not evident in this patient, it is possible the virus manifests differently in people with myeloma and other blood cancers.
“The patient in our study had chest tightness and shortness of breath, indicating that the clinical symptoms of COVID-19 are not typical in patients with coexisting comorbidities such as [multiple myeloma],” the researchers wrote.
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