Immunomodulatory Therapy for the Management of Severe COVID-19. Beyond the Anti-viral Therapy: A Comprehensive Review

Overview

Journal Autoimmun Rev

Publisher Elsevier

Specialty Allergy & Immunology

Date 2020 May 8

PMID 32376394

Citations 130

Authors

Jaume Alijotas-Reig

Enrique Esteve-Valverde

Cristina Belizna

Albert Selva-OCallaghan

Josep Pardos-Gea

Angela Quintana

Arsene Mekinian

Ariadna Anunciacion-Llunell

Francesc Miro-Mur

Affiliations

Soon will be listed here.

Abstract

Severe Acute Respiratory Syndrome related to Coronavirus-2 (SARS-CoV-2), coronavirus disease-2019 (COVID-19) may cause severe illness in 20% of patients. This may be in part due to an uncontrolled immune-response to SARS-CoV-2 infection triggering a systemic hyperinflammatory response, the so-called "cytokine storm". The reduction of this inflammatory immune-response could be considered as a potential therapeutic target against severe COVID-19. The relationship between inflammation and clot activation must also be considered. Furthermore, we must keep in mind that currently, no specific antiviral treatment is available for SARS-CoV-2. While moderate-severe forms need in-hospital surveillance plus antivirals and/or hydroxychloroquine; in severe and life-threating subsets a high intensity anti-inflammatory and immunomodulatory therapy could be a therapeutic option. However, right data on the effectiveness of different immunomodulating drugs are scarce. Herein, we discuss the pathogenesis and the possible role played by drugs such as: antimalarials, anti-IL6, anti-IL-1, calcineurin and JAK inhibitors, corticosteroids, immunoglobulins, heparins, angiotensin-converting enzyme agonists and statins in severe COVID-19.

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