Steven P. Treon, MD, PhD, on Treating COVID-19–Related Pulmonary Failure by Targeting BTK With Ibrutinib
August 11, 2020: Steven P. Treon, MD, PhD, of Dana-Farber Cancer Institute, discusses Bruton’s tyrosine kinase (BTK), which is activated during severe COVID-19 infection. Patients with the coronavirus and chronic lymphocytic leukemia who remained on the BTK inhibitor ibrutinib had a mild disease course, with decreased C-reactive protein and improved oxygenation. Clinical trials to validate the role of BTK inhibitors in treating COVID-19–related pulmonary distress are now underway.
Ibrutinib May Improve Pulmonary Outcomes in Certain COVID-19 Cases
Findings from a small clinical trial of patients with Waldenstrom’s macroglobulinemia (WM) suggest that ibrutinib may protect against lung injury and improve pulmonary function in hypoxic patients with COVID-19 (https://doi.org/10.1182/blood.2020006288).
https://www.oncnet.com/news/ibrutinib-may-improve-pulmonary-outcomes-certain-covid-19-cases
The BTK inhibitor ibrutinib may protect against pulmonary injury in COVID-19–infected patients
Letter To Blood | May 21, 2020
The Bruton tyrosine kinase (BTK) inhibitor ibrutinib is used to treat indolent B-cell malignancies and chronic graft-versus-host disease (cGVHD). The potential for ibrutinib to abrogate pulmonary inflammatory cytokines, lung injury, and death was demonstrated in a highly relevant lethal flu animal model.1 Therefore, we sought to clarify the impact of ibrutinib in COVID-19 patients. We care for 600 to 800 Waldenstrom macroglobulinemia (WM) patients each year, ∼300 of whom are on a BTK inhibitor. We identified 6 patients receiving ibrutinib for WM who were diagnosed with COVID-19; these patients consented to the use of their data. Their clinical characteristics appear in Table 1. Their median age was 66 years, and 5 were on the recommended treatment dose of 420 mg/d; the sixth patient was on a reduced dose of 140 mg/d because of arthralgias. For all patients, the median time on ibrutinib was 52 months. Their median time with COVID-19–related symptoms prior to diagnostic testing was 5 days, and the median time since diagnosis of COVID-19 was 22 days. All 6 patients experienced cough and fever as prodromal symptoms. The 5 patients on ibrutinib, 420 mg/d, did not experience dyspnea and did not require hospitalization. Their course was marked by steady improvement, and resolution or near resolution of COVID-19–related symptoms during the follow-up period.
Link to download the PDF Article: images/COVID-19/bloodbld2020006288.pdf
Potential Protective Effect of Ibrutinib Against Pulmonary Injury in Patients With COVID-19
April 30, 2020: In a letter published in the journal Blood, Steven P. Treon, MD, PhD, and colleagues reported a potential protective effect against pulmonary injury with the Bruton’s tyrosine kinase (BTK) inhibitor ibrutinib in patients diagnosed with COVID-19 who were receiving the agent for Waldenström’s macroglobulinemia.
Trial examines cancer drug as COVID-19 treatment
June 1, 2020: Dana-Farber Cancer Institute announced the launch of a randomized clinical trial evaluating the use of ibrutinib — an oral medication used to treat blood cancer — in patients with COVID-19. The clinical trial follows multiple case reports of patients who were receiving treatment with ibrutinib (Imbruvica; Janssen, Pharmacyclics) for Waldenström's macroglobulinemia and developed COVID-19 but did not experience shortness of breath, did not need to be hospitalized and improved steadily.
https://www.healio.com/news/primary-care/20200601/trial-examines-cancer-drug-as-covid19-treatment
Clinical Trials Regarding the effects of Ibrutinib on patients with COVID-19
https://clinicaltrials.gov/ct2/show/NCT04375397?term=ibrutinib&cond=COVID-19&draw=2&rank=1
