Review Article
Treatment strategies of COVID-19: A rheumatology perspective

https://doi.org/10.1016/j.ejim.2022.05.014Get rights and content

Highlights

  • COVID-19 is characterized by a systemic, uncontrolled inflammatory response of the innate and adaptive immunity, leading to exaggerated inflammation, named cytokine release syndrome. In the absence of an effective treatment, many off-label agents from the drug armamentarium of rheumatology are currently used.

  • Therapeutic strategies are divided into those that aim to target viral entry and its life cycle into the host cell and to those that target the inflammatory reaction.

  • The first approach comprises antiviral therapies aiming to reduce the viral replication and its load, among them the anti-SARS-CoV-2 mAbs.

  • The second approach focuses on the inhibition of cytokine cell receptors and it's signaling, leading to reduction of cytokine production. In this setting, systemic glucocorticoids, IL-6R antagonists and JAK inhibitors play a cardinal role.

Abstract

The clinical progression of the severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) to critical illness is associated with a systemic and uncontrolled inflammatory response of the innate and adaptive immunity with the release of a plethora of proinflammatory cytokines termed “cytokine storm”. In the absence of an effective treatment, many off-label agents from the armamentarium of rheumatology are used. Here, from the perspective of a rheumatologist, we will discuss the current therapeutic strategies in critically ill patients with SARS-CoV-2 pneumonia. Thus, we will discuss the agents that aim to target viral entry and its replication into the host cell and those focusing and targeting the inflammatory response. In this setting, many agents have been used with promising results but, not all have been approved by the International Authorities and Institutions. In the first step (viral entry), SARS-CoV-2 monoclonal antibodies and remdesivir have been approved to be used and, in the second step, corticosteroids along with interleukin-6 inhibitors, or Janus Kinase inhibitors are currently used.

Keywords

COVID-19
SARS-CoV-2 mAbs
Remdesivir
Colchicine
DMARDs
Dexamethasone

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