COVID Medication Also Helps Prevent Delirium
Research Led by Cedars-Sinai Found Patients Treated With a Medication Used to Treat COVID-19 Had Fewer Days of Delirium
Delirium, a condition that can have long-term effects on brain health, is common among patients with lung injury and a variety of other conditions. A study published in the peer-reviewed journal Scientific Reports and led by a Cedars-Sinai investigator found that a medication used to treat COVID-19 also reduces a patient’s chances of developing delirium or coma, which is a form of delirium.
“This study continues our investigation of a protein called IL-6, which is produced by the body’s immune system in response to infection or injury,” said Shouri Lahiri, MD, director of the Neurosciences Critical Care Unit at Cedars-Sinai and senior author of the study. “We’ve previously shown that modulating IL-6 reduces delirium in a laboratory mouse model that we developed. This study shows that the effect also translates to human patients.”
Lahiri and co-investigators from Vanderbilt University Medical Center reviewed data on 253 patients hospitalized with COVID-19. Sixty-nine of those patients were treated with tocilizumab, a medication known to help with survival and recovery from COVID-19 but not previously studied in delirium.
“Across the world, millions of patients are suffering from delirium while critically ill, including especially high rates in diseases like COVID,” said study co-author Wes Ely, MD, MPH, co-director of the Center for Critical Illness, Brain Dysfunction, and Survivorship at Vanderbilt University Medical Center. “Delirium is depersonalizing in the moment and can lead to long-term dementia-like memory impairments that impair people’s recovery. We are working diligently to find solutions to improve quality of care and help people find healing in survivorship.”
Patients treated with tocilizumab experienced significantly more days without developing delirium or coma than patients who did not receive tocilizumab. And this was true regardless of whether tocilizumab improved patients’ other symptoms.
“This is very important and a much stronger effect than I expected,” Lahiri said. “It shows that the drug may have been a major factor in preventing delirium, and that patients weren’t just avoiding delirium because their COVID symptoms improved.”
Helping patients reduce the severity and duration of delirium, or avoid it altogether, could also help them avoid long-term cognitive effects, Lahiri said.
“We know that delirium, especially coma, is associated with significant long-term cognitive changes and is considered one of the few potentially modifiable risk factors for dementia,” Lahiri said. “Recent research concluded that delirium triples a patient’s risk for dementia and doubles the rate of decline in patients who develop Alzheimer’s disease.”
Lahiri has also studied delirium in patients with urinary tract infections, and found that estrogen treatment, like tocilizumab, was associated with lower levels of IL-6 and delirium. He said that many different conditions besides COVID-19 can cause IL-6 levels to go up and increase risk of delirium. In future studies, he would like to directly test tocilizumab in patients with acute respiratory distress syndrome.
“These findings extend the previously reported benefits of tocilizumab to include the potential for significantly reduced delirium or coma episodes in patients with severe COVID-19,” said Nancy L. Sicotte, MD, chair of the Department of Neurology, the Women’s Guild Distinguished Chair in Neurology and professor of Neurology at Cedars-Sinai. “Confirmation of these findings in randomized prospective studies may lead to new pharmacological options for preventing or reducing risk of delirium and coma for patients experiencing critical illness.”
Funding: Dr. Ely has received a research grant from Dr. Franz Kohler Chemie GMBH and is supported by the NIH grants (R01 AG027472, R01 AG035117, R01 AG058639, I01RX002992). Dr. Lahiri is supported by a research grant from the F. Widjaja Foundation.
Additional authors include Tuqa Alkhateeb, PharmD; Joanna L. Stollings, PharmD; Ine Sohn, MS; Dandan Liu, PhD; and L. Montana Fleenor, PharmD.
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