Cyclosporine A and COVID19 – The COQUIMA cohort – Author's reply

Abstract

Thank you for your gentle comments about our manuscript under the format of a letter to the editor.These comments give positive feedback to our research. They also contribute to a scientific debate to boost the research on cyclosporine A for COVID-19.We thank Dr Mac e M Schuurmans and Dr Ren e Hage for their comments about our manuscript under the format of a letter to the editor. These comments give positive feedback to our research. They also contribute to a scientific debate to boost the research on cyclosporine A for COVID-19.Firstly, CsA might use in those patients in the second stage of SARS-CoV-2 infection, the pulmonary phase1 [1]. Hypoxemia and bilateral lung infiltrates or ground-glass opacities characterizes this phase. Most hospitals admit patients into wards during this disease phase. The hypoxemia -as mentioned in the manuscript-should be defined as saturation of oxygen below 94% or PaO 2 /FiO 2 < 300 mmHg. Typically, blood tests detect lymphopenia or transaminitis. A rise of inflammatory parameters, such as d-dimer, ferritin, and C-protein reactive, is also identified. Those cases in stage III, systemic hyperinflammation, are, of course, also suitable for CsA therapy. The transition between both phases is rather dynamic, and probable most hospitalized cases share features of both pulmonary and hyperinflammatory stages.Secondly, in our opinion, CsA therapy should start as soon as possible in hospitalized patients. It also might work as rescue therapy in those cases which do not improve after supportive measures. Nowadays, the best standard of care might include dexamethasone 6 mg q. i.d. intravenously [2] -and thrombosis prophylaxis with low-molecular-weight heparin.

Interventions for the prevention and treatment of COVID-19: a living mapping of research and living network meta-analysis

“…COVID-19 can cause various clinical manifestations, from nonspecific flu-like symptoms (fever, dry cough, fatigue) to severe hypoxaemia, multi-organ failure, and death (Novel 2020, Grasselli 2020, Goyal 2020, Guisado-Vasco 2020, Shah 2020WHO 2020, Cunningham 2020. Severe forms usually manifest a week a er the onset of symptoms.…”