Anti-inflammatory, immunomodulatory agents as potential strategies
against COVID-19: A systematic review
Abstract
Aim: SARS-COV-2 infections are causing substantial morbidity and
mortality, especially due to “exuberant cytokine storm”. In this study
we review effectiveness of anti-inflammatory and immunomodulatory drugs
in this situation. Methods: Ovid MEDLINE, PUBMED, Google Scholar and
Cochrane library searched for anti-inflammatory and immunomodulatory
drugs against COVID-19 including: Anti malaria agents, non-steroidal
anti-inflammatory drugs, steroids, cyclosporine, thalidomide, IVIG,
interlukin-6 blockade, IL-1 blockade, tumor necrosis factor-α blockade,
and Janus kinase inhibitors. Results: We included 95 studies. Unlike
preliminary positive results, the effect of Chloroquine is questionable.
Thalidomide has been shown to be effective in some studies but not be
proved yet. Low dose Corticosteroids may be effective in the early
phases of SARS-CoV-2 as a bridge. There is neither evidence of benefits
or adverse outcomes for the use of NSAIDs, nor is there evidence
indicating that target therapies (IL-1, TNFα and JAK inhibitors) and
also cyclosporine are effective. In some cases and clinical trials,
interlukin-6 blockade is useful in critically ill patients. Finally, the
high dose IVIG reversed the deterioration of patients in most clinical
trials. Conclusion: Unlike preliminary positive results,
Hydroxychloroquine seems ineffective. Thalidomide is effective in some
cases. Although, low dose CS may be effective in the early phases of
illness, administration of NSAIDs and steroids is controversial. The
effectiveness of more target therapies including IL-1, TNF-α, and JAK
inhibitors, also cyclosporine is less clear. Tocilizumab can be used in
severe situations, where other drugs are ineffective. IVIG can be used
at least as a bridge therapy in deteriorating patients.