Case Study: Patient with COVID-19 and Multiple Myeloma successfully treated with Tocilizumab

[Mike 03]

Source: The American Journal of Managed Care
Published on: April 25, 2020
Jared Kaltwasser

A new article outlining the experience of a patient with a history of multiple myeloma (MM) who contracted coronavirus disease 2019 (COVID-19) shows the interleukin 6-receptor inhibitor tocilizumab was an effective therapy.

The case occurred in China, and was written about in the current issue of Blood Advances. The patient, who lives in Wuhan, was first diagnosed with symptomatic MM back in 2015. Back then, a bone marrow aspirate showed 17.1% clonal plasma cells, and radiography showed multiple osteolytic bone lesions in frontal and temporal bone.

“His kidney biopsy confirmed amyloidosis; laboratory testing also showed proteinuria,” reports corresponding author Chengchang Zheng, PhD, of the University of Science and Technology of China. “The patient received 2 cycles of induction chemotherapy consisting of bortezomib, thalidomide, and dexamethasone, and his symptoms completely disappeared.”

The patient subsequently refused bortezomib-based treatment, Zheng reports, and was therefore given thalidomide as a maintenance therapy.

Five years later, the patient visited his local hospital in Wuhan on February 1, 2020, after experiencing chest tightness without a fever or cough. Physicians ordered a CT scan, which showed multiple ground-glass opacities and pneumatocele in both subpleural spaces. Doctors prescribed intravenous moxifloxacin and ordered nasopharyngeal tests for SARS-CoV-2, the virus that causes COVID-19. When the test came back positive, the patient was given 200 mg of the antiviral umifenovir, taken orally 3 times each day.

Read the article: https://www.ajmc.com/newsroom/report-describes-patient-with-mm-covid19-treated-successfully-with-tocilizumab

About Tocilizumab

Tocilizumab, also known as atlizumab, is an immunosuppressive drug, mainly for the treatment of rheumatoid arthritis (RA) and systemic juvenile idiopathic arthritis, a severe form of arthritis in children. It is a humanized monoclonal antibody against the interleukin-6 receptor (IL-6R). Interleukin 6 (IL-6) is a cytokine that plays an important role in immune response and is implicated in the pathogenesis of many diseases, such as autoimmune diseases, multiple myeloma and prostate cancer. It was developed by Hoffmann–La Roche and Chugai.[1]

https://en.wikipedia.org/wiki/Tocilizumab

My father passed away from Multiple Myeloma in 2011. I've been thinking about him and that I'm sort of glad he didn't have to go through this pandemic. The combination of the disease and therapies (including a bone marrow transplant) left him extremely immunosuppressed. Yet in this case study it appears an immunosuppressive drug (an IL-6 inhibitor) actually helped a MM patient fend off the illness. This case report demonstrates that there's surely reason to hope for cancer patients.

[Goodheart]

1. I hope it's true.

[at140]

2. Clinical trial with ONE patient?

That is NEW!

[Mike 03]

4. I don't think it was a clinical trial per se.

They are treating it as a "case report."

[at140]

9. OK that is better

please note that any one patient can recover on her/his own as well, and it may not be necessarily whatever treatment is being proscribed.

[matt819]

3. Who pays?

A single 4 milliliter dose is about $500, according to https://www.drugs.com/price-guide/actemra.

For that matter, who pays for any of the legitimate treatments that may emerge?

[Mike 03]

5. Those medications are exorbitantly expensive

Had it not been for medicare, I fear what would have happened to my father. One of his medicines (I think Revlimid) was $20,000 a month. They had supplemental insurance of some kind, I recall.

[mwooldri]

8. Since the case was in China - I don't know who pays.

But I bet it was cheaper there than in the USA

[captain queeg]

6. Interesting

[Silent3]

7. It *might* be worth looking at, but it's a single case study of a single patient...

...who had a whole lot of other complications and medications going on, making this pretty thin soup.

I'd say the only thing that gives Tocilizumab merit for further follow-up is that there's at least a plausible mechanism (the drug working as an IL-6 inhibitor) for therapeutic value.

[Mike 03]

10. Exactly true. This is a very specialized case.

It will be interesting to see the results of trials with other (hopefully less expensive) IL-6 inhibitors.

It's interesting that they treated an immunosuppressed person with an immunosuppressant. Or maybe there's some good reason for doing it that's not obvious to a layperson.

[gristy]

11. I'm glad this drug has two names - neither of which I can pronounce.

It would be too confusing for it to have just one. And one case study? One? Criminy.

[matt819]

12. And...

And much harder to pronounce or remember than Clorox or Lysol.

Hey, did Clorox issue a statement that people shouldn’t inject it? Asking for a friend.

[musette_sf]

13. K&R