Autoimmun Rev. Immunomodulatory therapy for the management of severe COVID-19. Beyond the anti-viral therapy: A comprehensive review

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Autoimmun Rev. 2020 May 3:102569. doi: 10.1016/j.autrev.2020.102569. [Epub ahead of print]
Immunomodulatory therapy for the management of severe COVID-19. Beyond the anti-viral therapy: A comprehensive review.


Alijotas-Reig J¹, Esteve-Valverde E², Belizna C³, Selva-O'Callaghan A⁴, Pardos-Gea J⁵, Quintana A⁶, Mekinian A⁷, Anunciacion-Lunell A⁶, Mir?-Mur F⁶.

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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.
Copyright ? 2020. Published by Elsevier B.V.



KEYWORDS:

Acute respiratory distress syndrome; COVID-19; Cytokine storm; Immunosuppressive; SARS-CoV-2; Treatment


PMID:32376394DOI:10.1016/j.autrev.2020.102569