Accelerating the Evolution of Severe Acute Respiratory Syndrome Coronavirus 2: A Risk of Combining Dexamethasone and Tocilizumab for Severe Coronavirus Disease 2019. (22nd June 2021)

• Record Type: Journal Article
• Authors: Koeckerling, David; Barker, Joseph
• Is Part Of: Journal of infectious diseases. Volume 224:Number 6(2021)
• Page Start: 934
• Page End: 937
• Publication Date: 2021-06-22
• Subjects: corticosteroids -- COVID-19 -- evolution -- IL-6 receptor inhibitors -- SARS-CoV-2 -- tocilizumab; Communicable diseases -- Periodicals; Diseases -- Causes and theories of causation -- Periodicals; Medicine -- Periodicals; Communicable Diseases -- Periodicals; Electronic journals; 616.9
• DOI: 10.1093/infdis/jiab328
• Languages: English
• ISSNs: 0022-1899

Abstract

Abstract: Emerging data from open-label randomized trials without placebo controls suggest potential mortality benefits for combining corticosteroids with the interleukin 6 receptor antagonist tocilizumab in severe coronavirus disease 2019. Conversely, dual immunomodulation may weaken antiviral responses and delay viral clearance, allowing severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) to expand its population and accrue genetic diversity within individual hosts. Generating a pool of hosts with genetically diverse viral populations while introducing new selective pressures in the form of vaccination-induced immunity could accelerate the process of antigenic drift in SARS-CoV-2. However, clinical trials to date have largely disregarded viral outcomes, and data on viral kinetics in response to immunomodulation are scarce. Coadministration of antiviral agents with immunomodulation could serve as a potential strategy to aid viral clearance and reduce the risk of genetic diversification. Abstract : Dual immunomodulation with corticosteroids and tocilizumab in COVID-19 may delay viral clearance and allow SARS-CoV-2 to accrue genetic diversity. Future trials assessing immunomodulation should report viral outcomes to delineate this risk. Coadministration of antiviral agents may prevent SARS-CoV-2 genetic diversification.