Therapeutic role of immunomodulators during the COVID-19 pandemic– a narrative review

ABSTRACT

The emergency state caused by COVID-19 saw the use of immunomodulators despite the absence of robust research. To date, the results of relatively few randomized controlled trials have been published, and methodological approaches are riddled with bias and heterogeneity. Anti-SARS-CoV-2 antibodies, convalescent plasma and the JAK inhibitor baricitinib have gained Emergency Use Authorizations and tentative recommendations for their use in clinical practice alone or in combination with other therapies. Anti-SARS-CoV-2 antibodies are predominating the management of non-hospitalized patients, while the inpatient setting is seeing the use of convalescent plasma, baricitinib, tofacitinib, tocilizumab, sarilumab, and corticosteroids, as applicable. Available clinical data also suggest the potential clinical benefit of the early administration of blood-derived products (e.g. convalescent plasma, non-SARS-CoV-2-specific immunoglobins) and the blockade of factors implicated in the hyperinflammatory state of severe COVID-19 (Interleukin 1 and 6; Janus Kinase). Immune therapies seem to have a protective effect and using immunomodulators alone or in combination with viral replication inhibitors and other treatment modalities might prevent progression into severe COVID-19 disease, cytokine storm and death. Future trials should address existing gaps and reshape the landscape of COVID-19 management.

KEYWORDS:

• SARS-CoV2
• COVID-19
• cytokine storm
• immunomodulation
• biologics

Authors’ contributions

All authors were involved in setting the review’s concept and objective and selection criteria. All authors participated in data extraction, synthesis, and interpretation. All authors provided input and agreed on the final version of the manuscript.

Acknowledgements

The authors thank Kuwait Association of Rheumatology for their support in preparing this manuscript. They also thank Racha Aaraj, Pharm D, MSc, MPH and Nancy Al Akkary, BSc, MSc from Phoenix Clinical Research, Lebanon for providing editorial and medical writing assistance for the preparation of this manuscript.

Disclosure of financial/other competing interests

The authors have no relevant conflicts of interest to disclose. Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Additional information

Funding

This work was supported by SOBI, which funded the development of the manuscript by Phoenix Clinical Research, Lebanon. None of the authors received an educational grant from SOBI to participate in the writing.