COVID Treatment Part 2: Disease-Modifying Treatments (DMTs)

29/12/2021

In our last article, we looked at common current treatments/therapies and preventative measures for COVID-19. Disease-modifying therapies are one such medication in the arsenal against COVID-19, though they are usually only administered to people with pre-existing conditions that put them at increased risk of experiencing more dangerous effects from COVID, or patients who already have a severe COVID infection.

What are DMTs?

Disease-modifying therapies, known as DMTs, aim to modulate the effects of the immune system when encountering certain diseases or conditions. They are most often used for auto-immune conditions such as MS, and work to tamp down an overactive or misguided immune response and reduce inflammation.

Inflammation often occurs in normal immune responses – usually cells release messenger molecules known as cytokines which help communicate to immune cells where to go to fight the infection, and what kind of response is required. Cytokines help regulate the immune system, notifying cells when there is trauma or infection that warrants attention. Cytokines can act as messengers locally or systemically (across the body). The influx of immune cells and their fighting off of pathogens at the site of infection can cause inflammation.

However, this usually well-controlled system can go horrifically wrong when the immune response is mis-directed (as it is in auto-immune diseases), or the body experiences severe illness and the subsequent immune response is exaggerated.

DMTs for COVID-19 can consist of a range of substances, such as monoclonal antibodies, antibodies or anticytokines such as IL-6 antagonists (to block receptors of interleukin 6, a pro-inflammatory antibody present during COVID infection) or JAK kinase inhibitors, and corticosteroids.

Cytokine Storms

In COVID-19, DMTs are given to certain patients at higher risk of severe disease, which is much more likely to provoke an overblown or otherwise inappropriate immune response due to other health conditions and their relevant treatments.

Some of the more severe effects associated with COVID are actually due to the immune response rather than the disease itself. With a severe COVID infection, the immune system may overreact when trying to fight off the disease and trigger conditions such as a cytokine storm – this is where extreme inflammation occurs due to large amounts of cell-communication molecules called cytokines being produced. As discussed earlier, cytokines are normally helpful, however in a cytokine storm where too great an amount of these messenger molecules are secreted, huge numbers of immune cells quickly gather in the one place to fight the infection, leading to larger levels of inflammation than usual. This can then cause damage to blood vessels, multi-organ failure, and in the case of COVID-19, damage to the lungs. Acute Respiratory Distress Syndrome (ARDS) has been linked with cytokine storms, and is a major cause of death.

What DMTs are given to COVID patients?

The administration of DMTs to COVID patients typically follows strict protocols. The exact DMTs administered generally depends on what stage of the disease the person is at, their current age, sex or health status, and any other medications or health conditions they may have.

for adults with conditions that may increase the severity of COVID, such as certain types of heart, kidney, lung or liver conditions, obesity, who are immunocompromised, or are elderly, disease-modifying treatments (DMTs) such as Sotrovimab, Budesonide or Casirivimab plus Imdevimab may be offered. These are typically administered within 5 to 7 days of disease onset, aiming to minimise disease progression and avoid severe illness and hospitalisation.

For moderate to severe cases of COVID-19 which typically require hospitalisation, DMTs such as Sotrovimab, Baricitinib, Tocilizumab or Casirivimab plus Imdevimab might be administered.

Some of these DMTs are not recommended for children aged 12 and under, nor are they always administered for women who are currently pregnant or breastfeeding.

Can I just take any DMT or DMARD for COVID?

In short – no. DMTs and DMARDs are used in a range of other health conditions, but generally cannot be used interchangeably as they are somewhat targeted treatments. It’s also important to note that if you are already using a particular DMT for another health condition, you should continue to take this and speak with your health professional if you have concerns. Studies have found the DMT you are taking for another health condition such as MS has no effect on the severity of COVID symptoms, however some DMARDs used for rheumatoid arthritis increased the likelihood of hospitalisation with COVID.

DMARDs such as hydroxychloroquine were promoted early on in the pandemic, however studies have found they were not effective for reducing COVID deaths, hospitalisation rates or the need for mechanical ventilation.

In our next article, we take a look at antivirals, and in Part 4 we’ll look at some of the other treatments publicised on the web or which are currently in trials.

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