Severe Neutropenia after Sarilumab Administration in Two COVID-19 Patients: Case Reports and Literature Review

Andrea Marino; Edoardo Campanella; Manuela Ceccarelli; Carmelo Bonomo; Maria Gussio; Cristina Micali; Benedetto Maurizio Celesia; Giuseppe Nunnari; Bruno Cacopardo

doi:10.3889/oamjms.2022.9337

Authors

Andrea Marino Department of Biomedical and Biotechnological Sciences, University of Catania, Catania, Italy; Department of Clinical and Experimental Medicine, Unit of Infectious Diseases, University of Catania, Catania, Italy https://orcid.org/0000-0002-5650-6911
Edoardo Campanella Department of Clinical and Experimental Medicine, Unit of Infectious Diseases, University of Messina, Messina, Italy
Manuela Ceccarelli Department of Clinical and Experimental Medicine, Unit of Infectious Diseases, University of Catania, Catania, Italy https://orcid.org/0000-0001-5987-3576
Carmelo Bonomo Department of Biomedical and Biotechnological Sciences, University of Catania, Catania, Italy https://orcid.org/0000-0001-5426-8799
Maria Gussio Department of Clinical and Experimental Medicine, Unit of Infectious Diseases, University of Catania, Catania, Italy
Cristina Micali Department of Clinical and Experimental Medicine, Unit of Infectious Diseases, University of Messina, Messina, Italy
Benedetto Maurizio Celesia Department of Clinical and Experimental Medicine, Unit of Infectious Diseases, University of Catania, Catania, Italy
Giuseppe Nunnari Department of Clinical and Experimental Medicine, Unit of Infectious Diseases, University of Messina, Messina, Italy
Bruno Cacopardo Department of Clinical and Experimental Medicine, Unit of Infectious Diseases, University of Catania, Catania, Italy

DOI:

https://doi.org/10.3889/oamjms.2022.9337

Keywords:

COVID-19 hyperinflammation, COVID-19, IL-6 drugs, Sarilumab, SARS-CoV2 infection

Abstract

BACKGROUND: Two years have passed since the WHO declared a pandemic state for SARS-CoV2 infection. COVID-19 pathogenesis consists of a first viral phase responsible for early symptoms followed by an inflammatory phase, which is cytokine-mediated, responsible for late-onset signs up to acute respiratory distress syndrome. Considering that interleukin (IL)6 plays a key role in the development and maintenance of inflammation, drugs targeting both IL6 and IL6 receptors have been evaluated.

CASE REPORTS: The present study reports the cases of two hospitalized patients with severe respiratory COVID-19 treated with a single dose of intravenous sarilumab, a monoclonal anti-IL6 antibody, along with standard of care medications and high-flow oxygen therapy. Although a few days following sarilumab administration, clinical and biochemical conditions started ameliorating, these patients developed severe and self-limiting neutropenia.

CONCLUSION: Sarilumab may represent a promising weapon to treat the fearsome hyperinflammatory phase; however, more trials are needed to decide whether to use it in combination with other drugs or alone, and to better understand pharmacokinetics and side effects.

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