Quality of evidence: C+
The Use of Anti-Inflammatory Drugs in the Treatment of People With Severe Coronavirus Disease 2019 (COVID-19): The Experience of Clinical Immunologists From China
Authors: Zhang W et al
Journal: Clinical Immunology
Objectives: Evaluate the interest and risks associated with anti-inflammatory treatments
Strength of evidence: Low/Moderate = C+ (narrative review, includes low-level evidence and expert advice)
Methods/publication type: Review and position paper, expert immunologist advice
Patients with severe forms
Highlights :
Clinical features include :
Peak inflammation around 1 and 2 weeks after onset with sudden deterioration of the disease
Lower level of lymphocytes (especially NK) cells in peripheral blood
Cytokine storm = increase in CRP, IL6, TNFa, IL 8, etc
Destroyed immune system (atrophy of spleen and lymph nodes, reduced lymphocytes in lymphoid organs)
Mostly monocyte infiltrations in the lungs
Mimicry of vasculitis, hypercoagulability (with possible severe thrombosis) and multiple organ damage
On anti-inflammatory drugs :
Might be useful to counter cytokine storm but risky because they might prevent response to infection
Corticosteroids might be efficient according to certain studies, However, no clear consensus and low-quality data = not currently recommended, if used, must be at a low dosage and in short courses in the cases most at risk (hemodynamic instability, ARDS)
Tocilizumab (anti-IL6) and JAK inhibitors are promising but still in trial with little known so far
Chloroquine and hydroxychloroquine have shown promising in vitro effects, and certain in vivo data (effect on exacerbation of pneumonia and viral load) but the evidence is still insufficient to show efficiency and safety (low-quality data) = not recommended for now
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