Immunomodulatory therapies for SARS-CoV-2 infection: a systematic literature review to inform EULAR points to consider

Review found little conclusive, and often conflicting data supporting immunomodulatory therapies for the management of COVID-19. Glucocorticoids were able to reduce mortality in specific subsets of patients, but this requires further study.

SPS commentary:

Based on this systematic review, the EULAR taskforce suggest the following points to consider on the pathophysiology and use of immunomodulatory therapies in COVID-19:

    In non-hospitalised patients with SARS-CoV-2 infection there is currently no evidence to support the initiation of immunomodulatory therapy
    In hospitalised patients with SARS-CoV-2 infection that do not need oxygen therapy there is currently no evidence to support the initiation of immunomodulatory therapy
    Hydroxychloroquine should be avoided for treating any stage of SARS-CoV-2 infection since it does not provide any additional benefit to the standard of care, and could worsen the prognosis in more severe patients particularly if coprescribed with azithromycin
    In patients with COVID-19 requiring supplemental oxygen, non- invasive mechanical ventilation, systemic glucocorticoids should be used since they can decrease mortality; most evidence concerns the use of dexamethasone
    An evolving RCT landscape cannot yet allow formal recommendation of the routine use of tocilizumab in patients with COVID-19 requiring oxygen therapy, non-invasive or invasive ventilation
    In COVID-19 there is no robust evidence to support the use of anakinra at any disease stage
    In patients with COVID-19 requiring non-invasive ventilation or high-flow oxygen, the combination of remdesivir plus baricitinib could be considered since it can decrease time to recovery and accelerate improvement in clinical status
      In COVID-19 there is currently insufficient evidence to recommend the use of other immunomodulators, including ruxolitinib, IVIg, convalescent plasma therapy except in Ig-deficient patients, IFN kappa, IFN beta, leflunomide, colchicine, sarilumab, lenzilumab, eculizumab, cyclosporine, IFN alpha, canakinumab

Annals of Rheumatic Diseases

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EULAR points to consider on pathophysiology and use of immunomodulatory therapies in COVID-19