The use of anti-inflammatory drugs in the treatment of people with severe coronavirus disease 2019 (COVID-19): The Perspectives of clinical immunologists from China

Abstract

The pandemic outbreak of coronavirus disease 2019 is rap idly spreading all over the world. Reports from China showed that about 20% of patients developed severe disease, resulting in a fatality of 4%. In the past two months, we clinical immunologists participated in mu lti-rounds of MDT (mult idiscipline team) discussion on the anti-inflammat ion management of critical ill COVID-19 patients, with our colleagues dispatched from Ch inese leading PUM C Hospital to Wuhan to admit and treat the most severe patients . Here, fro m the perspective of clinical immunologists, we will discuss the clin ical and immunological characteristics of severe patients, and summarize the current evidence and share our experience in anti-inflammat ion treatment, including glucocorticoids, IL-6 antagonist, JAK inhibitors and choloroquine/hydrocholoroquine, of patients with severe COVID-19 that may have an impaired immune system.

Targeting potential drivers of COVID-19: Neutrophil extracellular traps

“…Severe COVID-19 is associated with a cytokine storm characterized by increased plasma concentrations of IL1β, IL2, IL6, IL7, IL8, IL10, IL17, IFNγ, IFNγ-inducible protein 10, monocyte chemoattractant protein 1 (MCP1), G-CSF, macrophage inflammatory protein 1α, and TNFα (Huang et al, 2020; Mehta et al, 2020; Ruan et al, 2020; Wu et al, 2020; Wu and Yang, 2020; Zhang et al, 2020). These inflammatory mediators regulate neutrophil activity and induce the expression of chemoattractants (molecules that increase the trafficking of neutrophils to sites of inflammation).…”

“…Trans-signaling is strongly associated with pro-inflammatory states (Calabrese and Rose-John, 2014), and lower levels of sIL6Rα are associated with better lung function in, e.g., asthma (Ferreira et al, 2013; Hawkins et al, 2012). Neutrophils can shed sIL6Rα in response to IL8 (Marin et al, 2002), which is abundant in the COVID-19–associated cytokine storm (Wu and Yang, 2020; Zhang et al, 2020). Together, these findings lead us to speculate that antagonizing IL-6 trans-signaling and/or IL1β could be effective indirect strategies for targeting neutrophils and NETs in severe COVID-19.…”

Early intervention likely improves mortality in COVID-19 infection

“…Most of the lung injury associated with progressive COVID-19 relates to inflammation. 8,9 It seems that viral load falls off quite quickly in most, and then in some there is a hyperimmune reaction leading to destruction of lung tissue, with or without a systemic inflammatory response syndrome (SIRS). The subsequent hypoxia is itself pro-inflammatory and if undetected and uncorrected drives the inflammatory process forward.…”

Considerations for Statin Therapy in Patients with COVID‐19

“…2,3 Therefore, some Chinese researchers proposed or used anti-inflammatory agents in the treatment regimen of patients with COVID-19. 3,4 Statins are well known for their anti-inflammatory effects, 5 and some hospitals included them in the COVID-19 treatment protocol. 6 Here, we summarize the main points that should be considered before incorporating this class of drugs in a COVID-19 treatment regimen.…”