CoVID-19罹患中も生物学的製剤は継続するべき

重症喘息患者では生物学的製剤による分子標的治療も選択肢となる。COVID-19患者ではインターロイキン（IL）-4は増加または不変、IL-5は不変、IL-13は増加するなど、サイトカインの発現レベルに変化が生じることが報告されている（Clinic Rev Allerg Immunol 2020; 59: 78-88）。

　では、生物学的製剤を使用中の喘息患者がCOVID-19に罹患した場合、投与を中止した方がよいのだろうか。これに関して放生氏は、抗IgE抗体オマリズマブで治療中の重症喘息患者がCOVID-19に罹患したものの、喘息の増悪や肺炎を来すことなくウイルス陰性化まで経過したケーススタディを紹介（Allergy 2020年6月16日オンライン版）。

抗IL-5受容体抗体ベンラリズマブについても同様の症例報告がなされているという（J Asthma 2020年6月18日オンライン版、Ann Allergy Asthma Immunol 2020; 125: 357-359）。

　同氏は「抗IL-4/13受容体抗体デュピルマブについても、COVID-19経過中に問題なく継続できた重症喘息症例が最近報告された（Allergy 2020年8月6日オンライン版）。

これらを踏まえると、生物学的製剤を使用中の喘息患者がCOVID-19に罹患した場合、あえてやめる必要はないと考える」と述べた。

　なお、COVID-19流行期における重症喘息患者の生物学的製剤の使用について、米国アレルギー·喘息·免疫学会（AAAAI）と世界アレルギー機構（WAO）は「生物学的製剤がCOVID-19に有害だというデータはなく、中止による喘息コントロールの悪化が懸念される」といった理由で、継続することを促している。

＜管理者私見＞

CoVID-19ではサイトカインが上昇し、アクテムラのような抗サイトカイン療法は有効である可能性が高く、また原疾患である喘息等が悪化する可能性があるため、自己判断で止めるべきではない。

（※　管理者注　2020/09/16記載）

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https://pubmed.ncbi.nlm.nih.gov/32468411/

COVID-19 and Asthma: Reflection During the Pandemic

Shuang Liu 1 2 , Yuxiang Zhi 3 , Sun Ying

Clin Rev Allergy Immunol. 2020 Aug;59(1):78-88. doi: 10.1007/s12016-020-08797-3.

PMID: 32468411 DOI: 10.1007/s12016-020-08797-3

Abstract

Coronavirus disease 2019 (COVID-19) is a global pandemic infectious disease caused by severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2), and abnormal, overactivated innate immunity and "cytokine storms" have been proposed as potential pathological mechanisms for rapid COVID-19 progression. Theoretically, asthmatic patients should have increased susceptibility and severity for SARS-CoV-2 infection due to a deficient antiviral immune response and the tendency for exacerbation elicited by common respiratory viruses. However, existing studies have not shown an expected prevalence of asthmatic individuals among COVID-19 patients. Certain aspects of type 2 immune response, including type 2 cytokines (IL-4, IL-13, etc.) and accumulation of eosinophils, might provide potential protective effects against COVID-19. Furthermore, conventional therapeutics for asthma, including inhaled corticosteroids, allergen immunotherapy (AIT), and anti-IgE monoclonal antibody, might also reduce the risks of asthmatics suffering infection of the virus through alleviating inflammation or enhancing antiviral defense. The interactions between COVID-19 and asthma deserve further attention and clarification.

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https://pubmed.ncbi.nlm.nih.gov/32544254/

COVID-19 in a patient with severe asthma treated with Omalizumab

Marek Lommatzsch 1 , Paul Stoll 1 , Johann Christian Virchow 1

Allergy. 2020 Jun 16;10.1111/all.14456. doi: 10.1111/all.14456. Online ahead of print.

PMID: 32544254 PMCID: PMC7323189 DOI: 10.1111/all.14456

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https://pubmed.ncbi.nlm.nih.gov/32519921/

J Asthma. 2020 Jun 18;1-3. doi: 10.1080/02770903.2020.1781165. Online ahead of print.

COVID-19 in a severe eosinophilic asthmatic receiving benralizumab - a case study

Andreas Renner , Katharina Marth , Karin Patocka , Wolfgang Pohl

PMID: 32519921 DOI: 10.1080/02770903.2020.1781165

Abstract

Introduction: Only little is known about COVID-19 in patients with asthma. There is no data on COVID-19 in patients with severe asthma or patients with asthma who are treated with monoclonal antibodies.Case Study: Here, we present the case of a severe eosinophilic asthmatic in whom benralizumab treatment, an anti-IL-5R monoclonal antibody, was initiated 2 years ago. Prior to benralizumab treatment, every viral infection had resulted in a prolonged course of oral corticosteroids (OCS). Since initiation of benralizumab, the patient has had good asthma control. Mid-March 2020, the patient developed high fever.Results: A SARS-CoV-2-PCR (nasopharyngeal swab) was positive. The patient's symptoms subsided after few days. No OCS was needed. The asthma control questionnaire 6-item scale worsened moderately in the week of the infection and returned to normal levels thereafter. The asthma control test, measuring longer term asthma control, showed no decline.Conclusion: The course of COVID-19 was very mild in this particular patient with severe eosinophilic asthma. So far, there is no evidence that would suggest a more severe course of COVID-19 in patients with asthma. It is worth noting, that prior to the initiation of benralizumab this patient had multiple exacerbations per year triggered by viral infections (4/year), which all required OCS. Whilst only anecdotal, this case study provides the first evidence to support the current recommendation of continuing monoclonal antibodies in patients with severe asthma during the COVID-19 pandemic.

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https://pubmed.ncbi.nlm.nih.gov/32553608/

COVID-19, severe asthma, and biologics

Ismael García-Moguel , Rocío Díaz Campos , Sergio Alonso Charterina , Consuelo Fernández Rodríguez , Jesús Fernández Crespo

Ann Allergy Asthma Immunol. 2020 Sep;125(3):357-359.e1. doi: 10.1016/j.anai.2020.06.012. Epub 2020 Jun 14.

PMID: 32553608 PMCID: PMC7293849 DOI: 10.1016/j.anai.2020.06.012

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https://pubmed.ncbi.nlm.nih.gov/32767400/

Dupilumab, severe asthma airway responses,

and SARS-CoV-2 serology

Anurag Bhalla , Manali Mukherjee , Katherine Radford , Ishac Nazy , Melanie Kjarsgaard , Dawn M E Bowdish , Parameswaran Nair

Allergy. 2020 Aug 6;10.1111/all.14534. doi: 10.1111/all.14534. Online ahead of print.

PMID: 32767400 PMCID: PMC7436521 DOI: 10.1111/all.14534

Abstract

There is paucity of evidence assessing immune responses to COVID‐19 in severe asthmatics treated with biologics. Recent guidelines recommend continuing these agents (as clinically indicated) to maintaining asthma control. Supporting this claim, Lommatzsch demonstrated that omalizumab could safely be continued during active COVID‐19 infection in a patient with allergic asthma.1 There are other emerging reports that show that treatment with benralizumab2 and dupilumab3 is not associated with significant negative impact. We had similar experience in a young patient with severe asthma treated with dupilumab.