Current and emerging immunomodulators for treatment of SARS-CoV2 infection (COVID-19)

ABSTRACT

Introduction

SARS-CoV-2, the virus that causes COVID-19, elicits a variety of host responses ranging from asymptomatic or mild illness in most people, to severe disease and critical illness in a subset of patients with systemic inflammation and hypoxemic respiratory failure.

Areas Covered

Heterogeneous clinical presentations are often driven by disparate responses of the host immune system, with severe disease associated with aberrant interferon signaling or cytokine storm syndrome. This manuscript examines current therapeutic approaches, including the use of immunomodulators such as corticosteroids, interleukin inhibitors, kinase inhibitors, fluvoxamine, and ivermectin, and also explores the ways that these therapies and others may be used to treat COVID-19 in the future.

Expert opinion

Modulation of the immune response has become a mainstay of treatment of COVID-19, although the optimal mechanism has not yet been defined and there is considerable controversy regarding clinical management. As time progresses, the therapeutic approach to COVID-19 will undoubtedly change, particularly as we learn more about the pathophysiology of SARS-CoV-2 infection.

KEYWORDS:

• COVID-19
• immunomodulator
• SARS-CoV-2
• inflammation
• cytokine storm

Article highlights

*Severe COVID-19 is associated with misfiring of the human immune system.

*Systemic corticosteroids have become a mainstay of treatment for hospitalized patients with COVID-19 who require supplemental oxygen.

*Tocilizumab is an interleukin-6 receptor antagonist approved for patients with rheumatologic disorders and has improved outcomes in a subset of hospitalized COVID-19 patients with signs of systemic inflammation and increasing oxygen requirements.

*Janus kinase (JAK) inhibitors interfere with cell signaling and signal transduction that leads to immune activation and have improved outcomes in some hypoxic hospitalized patients with COVID-19

*The antidepressant fluvoxamine has shown promise for outpatients newly diagnosed with COVID-19

Declaration of interest

The author has no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Additional information

Funding

This manuscript has not been funded.