Pharmacotherapy of Cytokine Release Syndrome in Severe COVID-19 Patients: A Systematic Review

Abstract

The coronavirus pandemic which spread from Wuhan China toward the latter part of 2019 has resulted in 216,303,376 confirmed cases and 4,498,451deaths deaths to date. The novelty and lack of a definitive treatment protocol for the virus and the acute respiratory distress syndrome it produces has resulted in patients being placed on artificial ventilation and most often never recovering therefrom. Very little is known about the pathophysiology of the virus and the biological mechanisms in which it disrupts to bring about the now identified wide array of clinical features which are not solely isolated to the respiratory tract. It is now an established fact however, that one of the major pathways implicated and on which often results in the death and or severe complications in COVID-19 patients is the cytokine storm. The use of new drugs to combat such a cytokine storm is thus important considering the current global COVID-19 situation so as to stop the further progression of the disease in patients and decrease both morbidity and mortality by crippling a major mechanism which hastens death in the hosts. It is, therefore, vital that a systematic analysis and review of the various therapeutic agents are undertaken to select the best drug for the treatment of patients with cytokine storm. This research aims to relate the best therapeutic regimens currently available precisely and concisely to physicians so as to ensure the best possible treatment modality is selected for each patient. An extensive review of the literature was done on the following databases: Google scholar, Trip database, EMBASE, PubMed, and PubMed Central. The keywords and the Boolean operators used for searches were “COVID-19” OR “SARS-CoV-2” AND “Therapeutics” OR “drug therapy” AND “Cytokine Release Syndrome.” The discovery and the use of such drugs, namely, Tocilizumab and potent corticosteroids such as dexamethasone and methylprednisolone in the maximum daily doses of 6 mg and 250 mg, respectively, have shown positive outcome to combat cytokine storm in severe COVID-19 patients. The rationale behind the use of these drugs being to suppress the immune system and thus decrease the detrimental cytokine cascade induced in severely ill COVID-19 patients will be instrumental in the treatment and prevention of severe complication. It is vital for the various drugs under trial and implemented in emergency use to be compared and studied so as to best select the drug which can be incorporated into a treatment regimen which is both effective and has diminished adverse effects.