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Effect of tocilizumab and thymalin on systemic inflammation in patients with COVID-19

DOI: https://doi.org/10.29296/25877305-2020-11-17
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Professor B. Kuznik(1, 2), MD; Professor V. Khavinson(3, 4), Corresponding Member of the
Russian Academy of Sciences, MD; S. Lukyanov, Candidate of Medical Sciences; Professor K. Shapovalov(1, 5),
MD; Yu. Smolyakov(1, 2), Candidate of Medical Sciences; P. Tereshkov(1), Candidate of Medical Sciences; Yu.
Shapovalov(1, 5); V. Konnov(1, 5), Candidate of Medical Sciences; Associate Professor D. Zaitsev(1), MD;
Professor E. Magen(6), MD (1)Chita State Medical Academy (2)Innovation Clinic, Academy of Health, Chita
(3)Saint Petersburg Institute of Bioregulation and Gerontology (4)I.P. Pavlov Institute of Physiology,
Russian Academy of Sciences, Saint Petersburg (5)City Clinical Hospital One, Chita (6)David Ben-Gurion
University, Ashdod, Israel

Severe COVID-19 accompanied by acute respiratory failure, acute respiratory distress syndrome, and multiple organ dysfunction is most often observed in older (over 65 years) and relatively young patients with concomitant diseases, such as diabetes mellitus, hypertensive disease, cardiac, renal, or hepatic dysfunction. In this case, the patients develop an excessive inflammatory response accompanied by the development of a cytokine storm, by the imbalance and subsequent depletion of T-cell immunity. Successful therapy for COVID-19 is based on the restoration of impaired immune functions, as well as on the elimination of the cytokine storm. For this purpose, it is recommended that the recombinant monoclonal antibody IL-6 (RIL) receptor inhibitor tocilizumab be used. The paper gives information on the successful use of tocilizumab in patients with severe COVID-19 and shows its substantial disadvantages: the development of adverse reactions, such as lymphocytopenia, thrombocytopenia, and elevated levels of IL6, alanine and aspartate aminotransferase, etc. At the same time, there are rationales that these patients should be given the immunomodulator thymalin that is able to eliminate the cytokine storm, to normalize the immune system, and to prevent disseminated intravascular coagulation. The authors describe typical cases of severe COVID-19 treated with tocilizumab and thymalin alone and in combination.

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