Immunomodulation as Treatment for Severe Coronavirus Disease 2019: A Systematic Review of Current Modalities and Future Directions

Eric A. Meyerowitz, Pritha Sen, Sara R. Schoenfeld, Tomas G. Neilan, Matthew J. Frigault, John H. Stone, Arthur Y. Kim, Michael K. Mansour

Research output: Contribution to journalReview articlepeer-review

Abstract

In severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection, viral load peaks early and declines quickly after symptom onset. Severe coronavirus disease 2019 (COVID-19) is marked by aberrant innate and adaptive immune responses with an abnormal cytokine profile and multiorgan system dysfunction that persists well after viral clearance. A purely antiviral treatment strategy may therefore be insufficient, and antiviral agents have not shown a benefit later in the illness course. A number of immunomodulatory strategies are being tested, including corticosteroids, cytokine and anticytokine therapies, small molecule inhibitors, and cellular therapeutics. To date, the only drug to show a mortality benefit for COVID-19 in a randomized, controlled trial is dexamethasone. However, there remains uncertainty about which patients may benefit most and about longer-term complications, including secondary infections. Here, we review the immune dysregulation of severe COVID-19 and the existing data behind various immunomodulatory strategies, and we consider future directions of study.

Original languageEnglish (US)
Pages (from-to)E1130-E1143
JournalClinical Infectious Diseases
Volume72
Issue number12
DOIs
StatePublished - Jun 15 2021

Keywords

  • COVID-19
  • SARS-CoV-2
  • cytokine storm
  • hyperinflammatory
  • immunomodulation

ASJC Scopus subject areas

  • Microbiology (medical)
  • Infectious Diseases

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