Department of Haematology, Imperial College Healthcare and NHS Trust Hammersmith Hospital, 72 Du Cane Rd, London, W12 0HS, United Kingdom.
Department of Haematology, Imperial College Healthcare and NHS Trust Hammersmith Hospital, 72 Du Cane Rd, London, W12 0HS, United Kingdom.
Int J Infect Dis. 2021 Apr;105:274-276. doi: 10.1016/j.ijid.2021.02.056. Epub 2021 Feb 16.
Immune modulation in COVID-19 is emerging as an important therapeutic strategy as increasing evidence suggests that inflammatory pathways are implicated in lung damage. Bruton tyrosine kinase inhibitors (BTKi), such as ibrutinib, are commonly used to treat indolent B-cell neoplasms and chronic graft-versus-host disease (GvHD). Given their potential to suppress pulmonary inflammatory cytokines and lessen acute lung injury, this could be applicable in the context of hospitalised COVID-19 patients. We describe an 81 year-old male receiving ibrutinib for Waldenstrom macroglobulinaemia (WM) who was hospitalised with COVID-19. On stopping the BTKi due to concerns of additional immunosuppression, he required non-invasive ventilation (NIV) in the intensive care unit (ICU) and demonstrated prompt clinical recovery when ibrutinib was reinstated. Continuing ibrutinib in patients with COVID-19 may be advantageous given its immunomodulatory properties and withdrawal of ibrutinib therapy may be detrimental. Further evidence is required to explore the potential therapeutic impact of BTKis and other immunomodulatory agents on the clinical course of COVID-19 as is currently being carried out in a number of clinical trials.
在 COVID-19 中，免疫调节作为一种重要的治疗策略正在出现，越来越多的证据表明炎症途径与肺部损伤有关。布鲁顿酪氨酸激酶抑制剂（BTKi），如伊布替尼，常用于治疗惰性 B 细胞肿瘤和慢性移植物抗宿主病（GvHD）。鉴于它们有可能抑制肺部炎症细胞因子并减轻急性肺损伤，这在住院 COVID-19 患者的情况下可能适用。我们描述了一名 81 岁男性，因患有 Waldenstrom 巨球蛋白血症（WM）而接受伊布替尼治疗，他因 COVID-19 住院。由于担心额外的免疫抑制作用，停止使用 BTKi 后，他需要在重症监护病房（ICU）进行无创通气（NIV），当重新开始使用伊布替尼时，他迅速康复。鉴于其免疫调节特性，继续在 COVID-19 患者中使用伊布替尼可能是有利的，而停用伊布替尼治疗可能有害。目前正在进行多项临床试验，需要进一步的证据来探讨 BTKi 和其他免疫调节剂对 COVID-19 临床病程的潜在治疗影响。
