Immunomodulatory drug therapy for the disease caused by SARS-CoV-2 infection (COVID-19)

Abstract

This systematic review focuses on the state-of-the-art pharmacotherapy of immune disorders in the novel coronavirus infection (COVID-19), leading to a cytokine storm and uncontrolled inflammatory response that causes severe tissue damage and multiple organ failure. A lot of theoretical, experimental and clinical data support the need for immunomodulatory (immunosuppressive) therapy for this disease. It should be emphasized that all immunomodulatory drugs for COVID-19 are prescribed off label, and the evidence base of the results of randomized trials is just being accumulated. We review the immunomodulatory therapy for COVID-19 with the following agents: glucocorticoids, hydroxychloroquine and chloro-quine, type 1 interferons, interleukin-6 antagonists (tocilizumab, sarilumab, olokizumab), interleukin-1 p inhibitor canakinumab, tumour necrosis factor inhibitors (infliximab), Janus kinase (JAK) inhibitors (tofacitinib, baricitinib, ruxolitinib), as well as drugs with other mechanisms of action (abatacept, nivolumab, tacrolimus, sirolimus, fingolimod, melphalan, cyclosporine, methotrexate). At the moment, the most reasonable is the use of interleukin-6 receptor inhibitors, intermediate and high dose glucocorticoids, and JAK inhibitors. Based on the latest data from clinical studies, especially the "Solidarity” trial, the use of hydroxychloroquine and chloroquine seems to have insufficient evidence. There are significant pathophysiological overlaps in the development of immunopathology in COVID-19 and in rheumatic diseases, and the strategy of early aggressive immunosuppressive therapy proposed by a number of researchers almost completely coincides with the current strategies for rheumatoid arthritis.

Experience of using tocilizumab in the research unit of infectious hospital for patients with coronavirus infection (CoVID-19)

“…Middle East respiratory syndrome -ближневосточный респираторный синдром). Исследования показали, что непосредственной причиной поражения легочной ткани являлась не репликация вируса в альвеолоцитах, а чрезмерный иммунный ответ, сопровождавшийся повреждением собственных клеток [3]. Обоснованием для использования ингибиторов интерлейкинов при тяжелом течении коронавирусной инфекции COVID-19 является необходимость предупреждения и угнетения развития синдрома высвобождения цитокинов («цитокинового шторма»), создающего угрозу возникновения и прогрессирования острого респираторного дистресс-синдрома, полиорганной недостаточности и смерти.…”