Abstract
Objective
To summarise the available information on efficacy and safety of
immunomodulatory agents in SARS-CoV-2 infection.
Methods
As part of a European League Against Rheumatism (EULAR) taskforce, a systematic
literature search was conducted from January 2019 to 11 December 2020. Two reviewers
independently identified eligible studies according to the Population, Intervention,
Comparator and Outcome framework and extracted data on efficacy and safety of
immunomodulatory agents used therapeutically in SARS-CoV-2 infection at any stage. The
risk of bias was assessed with validated tools.
Results
Of the 60 372 records, 401 articles were eligible for inclusion. Studies were at
variable risk of bias. Randomised controlled trials (RCTs) were available for the
following drugs: hydroxychloroquine (n=12), glucocorticoids (n=6), tocilizumab (n=4),
convalescent plasma (n=4), interferon beta (n=2), intravenous immunoglobulins (IVIg)
(n=2) and n=1 each for anakinra, baricitinib, colchicine, leflunomide, ruxolitinib,
interferon kappa and vilobelimab. Glucocorticoids were able to reduce mortality in
specific subsets of patients, while conflicting data were available about tocilizumab.
Hydroxychloroquine was not beneficial at any disease stage, one RCT with anakinra was
negative, one RCT with baricitinib+remdesivir was positive, and individual trials on
some other compounds provided interesting, although preliminary, results.
Conclusion
Although there is emerging evidence about immunomodulatory therapies for the
management of COVID-19, conclusive data are scarce with some conflicting data. Since
glucocorticoids seem to improve survival in some subsets of patients, RCTs comparing
glucocorticoids alone versus glucocorticoids plus anticytokine/immunomodulatory
treatment are warranted. This systematic literature review informed the initiative to
formulate EULAR ‘points to consider’ on COVID-19 pathophysiology and immunomodulatory
treatment from the rheumatology perspective.
Funder
European League Against
Rheumatism
Subject
General Biochemistry, Genetics and Molecular Biology,Immunology,Immunology and Allergy,Rheumatology
Cited by
30 articles.
订阅此论文施引文献
订阅此论文施引文献,注册后可以免费订阅5篇论文的施引文献,订阅后可以查看论文全部施引文献