The role of ibrutinib in COVID-19 hyperinflammation: A case report. (April 2021)

• Record Type: Journal Article
• Authors: Maynard, Suzanne; Ros-Soto, Jose; Chaidos, Aris; Innes, Andrew; Paleja, Krushika; Mirvis, Eitan; Buti, Noora; Sharp, Harriet; Palanicawandar, Renuka; Milojkovic, Dragana
• Is Part Of: International journal of infectious diseases. Volume 105(2021)
• Page Start: 274
• Page End: 276
• Publication Date: 2021-04
• Subjects: COVID-19 -- BTK-inhibitor -- Ibrutinib -- Waldenstrom macroglobulinaemia; Communicable diseases -- Periodicals; Communicable Diseases -- Periodicals; Communicable diseases; Periodicals; Electronic journals; 616.9
• DOI: 10.1016/j.ijid.2021.02.056
• Languages: English
• ISSNs: 1201-9712

Abstract

Highlights: Immunomodulation by ibrutinib may be advantageous in COVID-19 hyperinflammation. Withdrawal of ibrutinib therapy in COVID-19 infection may be detrimental. Bruton tyrosine kinase inhibitors impact on hyperinflammation needs more research. Abstract: Immune modulation in COVID-19 is emerging as an important therapeutic strategy as increasing evidence suggests that inflammatory pathways are implicated in lung damage. Bruton tyrosine kinase inhibitors (BTKi), such as ibrutinib, are commonly used to treat indolent B-cell neoplasms and chronic graft-versus-host disease (GvHD). Given their potential to suppress pulmonary inflammatory cytokines and lessen acute lung injury, this could be applicable in the context of hospitalised COVID-19 patients. We describe an 81 year-old male receiving ibrutinib for Waldenstrom macroglobulinaemia (WM) who was hospitalised with COVID-19. On stopping the BTKi due to concerns of additional immunosuppression, he required non-invasive ventilation (NIV) in the intensive care unit (ICU) and demonstrated prompt clinical recovery when ibrutinib was reinstated. Continuing ibrutinib in patients with COVID-19 may be advantageous given its immunomodulatory properties and withdrawal of ibrutinib therapy may be detrimental. Further evidence is required to explore the potential therapeutic impact of BTKis and other immunomodulatory agents on the clinical course of COVID-19 as is currently being carried out in a number of clinical trials.