Infectious Disease

Immunomodulatory remedy could be efficient for COVID-19 subgroups

February 26, 2021

2 min read

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Alunno does not report any relevant financial information. In the study you will find all relevant financial information from all other authors.

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Patients with COVID-19 who require supplemental oxygen or non-invasive or mechanical ventilation should receive systemic glucocorticoids as they can reduce mortality according to EULAR points.

The items published in the Annals of the Rheumatic Diseases also recommend providers consider a combination of remdesivir (Veklury, Gilead Sciences) and baricitinib (Olumiant, Eli Lilly & Co.) in patients with COVID-19 who are non-invasive Need ventilation or high flow oxygen as they can reduce the time to recovery and accelerate clinical improvement.

Patients with COVID-19 who require supplemental oxygen or non-invasive or mechanical ventilation should receive systemic glucocorticoids as they can reduce mortality according to EULAR points. Source: Adobe Stock

“As rheumatologists are pioneers in the use of immunomodulatory therapies, they are well placed to gain insight into their use, their safety profile, and the timing of possible mitigation of the severe inflammatory responses associated with SARS-CoV-2 infection.” Alessia Alunno, MD, PhD, from the University of Perugia in Italy and colleagues. “While there is already an extremely large volume of publications available, most of the research is descriptive and definitive randomized controlled trials (RCTs) remain scarce.”

“In this rapidly evolving landscape, and given the need to optimally define therapeutic solutions, it is of vital importance to guide the medical and scientific community based on the best available knowledge,” they added. “This is especially the case when antivirals have so far not shown any significant improvement in survival from COVID-19.”

In order to develop and elaborate points to be considered in relation to the pathophysiology and immunomodulatory COVID-19 therapies from a rheumatological point of view, EULAR organized an international 24-person task force comprising rheumatologists, translational immunologists, hematologists, pediatric rheumatologists, methodologists and a healthcare professional and a patient representative. This task force met for four virtual meetings in July and November 2020.

The members carried out a systematic literature search on individual studies on COVID-19 pathophysiology and its management with immunomodulatory therapies with a deadline of December 15, 2020. The final overarching principles and points to be considered were drawn up and formalized through a series of formal votes and finally ratified by the EULAR Executive Committee.

Overall, the task force developed and approved two overarching principles that highlighted the heterogeneity of COVID-19 and 14 points to consider, split between disease pathophysiology and management with immunomodulators. The two overarching principles are:

The phenotype of COVID-19 is heterogeneous, ranging from asymptomatic to fatal diseases due to multiple organ damage. and

COVID-19 may require different treatment strategies, including antiviral, oxygen, anticoagulant and / or immunomodulatory treatment at different stages of the disease.

The first six points to consider relate to the pathophysiology of the disease, including immune response, endothelial dysfunction, and biomarkers. Points seven to 14 focus on management with immunomodulatory therapy.

According to the task force, there is evidence of the use of glucocorticoids, particularly dexamethasone, in COVID-19 cases where oxygen therapy is required. However, to date no other immunomodulator has shown effectiveness in mortality. In addition, there was no evidence of the use of immunomodulatory therapy in out-of-hospital patients or in those in-hospital who do not require oxygen. Immunomodulatory treatment was not associated with higher infection rates, the member noted.

“This EULAR [points to consider (PtCs)] provide relevant guidelines on the pathophysiology of SARS-COV-2 infection, in particular on the use of immunomodulatory therapies from a rheumatological point of view, ”wrote Alunno and colleagues.

“Indeed, with initial viral alveolitis followed by immune thrombosis and evidence available, the pathophysiology suggests a central role for immunomodulatory therapy, especially glucocorticoids, in improving disease survival in severe COVID-19,” they added. “These first EULAR PtCs are designed to evolve and should be updated to reflect the rapid increase in knowledge about the disease and the upcoming vaccines.”

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