International #COVID-19 trial to restart with focus on immune responses
▻https://www.nature.com/articles/d41586-021-01090-z
Nouveaux essais thérapeutiques par #solidarity et #REMAP-CAP
One of the drugs to be tested is infliximab, used to treat autoimmune conditions, including Crohn’s disease and rheumatoid arthritis. It blocks a protein called tumour necrosis factor alpha (TNF-α), which is released by immune cells called macrophages and promotes inflammation.
A second treatment in the trial is a cancer drug called imatinib. Researchers hope that it will target both the coronavirus and inflammation, blocking viral infiltration of human cells and reducing the activity of pro-inflammatory proteins called cytokines. Finally, Solidarity is testing artesunate, an anti-malaria drug with potential anti-inflammatory effects. Each of these drugs will be given alongside standard care, which in many regions includes dexamethasone, says Røttingen.
REMAP-CAP also plans to test imatinib, which could help to prevent leaking of fluids in the blood vessels surrounding the lungs, says Gordon. The trial will also test a different drug that targets TNF-α, as well as a drug called namilumab that blocks a protein called GM-CSF and that could reduce cytokine activity.
With all of these ways to cool down the immune system, researchers have to be careful that they don’t suppress immune responses so much that people become vulnerable to other infections, says Djillali Annane, an intensive-care physician at the University of Versailles in Saint-Quentin-en-Yvelines, France, and a member of the REMAP-CAP international steering committee.
In the REMAP-CAP trial, participants will first be given a steroid, such as dexamethasone, and a drug that blocks IL-6 receptors. Participants will be given an additional drug to target the immune system only if they fail to improve after the first two. “This is targeting those patients who do not respond,” says Annane. “Then the question is, if we add on another way to modulate the inflammatory response in these patients, can we save additional lives?”