Immunomodulatory therapies for the treatment of SARS-CoV-2 infection: an update of the systematic literature review to inform EULAR points to consider

Alunno, A., Najm, A. , Mariette, X., De Marco, G., Emmel, J., Mason, L., McGonagle, D. G. and Machado, P. M. (2021) Immunomodulatory therapies for the treatment of SARS-CoV-2 infection: an update of the systematic literature review to inform EULAR points to consider. RMD Open, 7, e001899. (doi: 10.1136/rmdopen-2021-001899) (PMID:34725262) (PMCID:PMC8562527)

Abstract

Objective: To update the EULAR 2020 systematic literature review (SLR) on efficacy and safety of immunomodulatory agents in SARS-CoV-2 infection. Methods: As part of a EULAR taskforce, a systematic literature search update was conducted from 11 December 2020 to 14 July 2021. Two reviewers independently identified eligible studies and extracted data on efficacy and safety of immunomodulatory agents used therapeutically in SARS-CoV-2 infection at any stage of disease. The risk of bias (RoB) was assessed with validated tools. Results: Of the 26 959 records, 520 articles were eligible for inclusion. Studies were mainly at high or unclear RoB. New randomised controlled trials (RCTs) on tocilizumab clarified its benefit in patients with severe and critical COVID-19, mainly if associated with glucocorticoids. There are emergent data on the usefulness of baricitinib and tofacitinib in severe COVID-19. Other therapeutic strategies such as the use of convalescent plasma and anti-SARS-CoV-2 monoclonal antibodies showed efficacy in subjects not mounting normal anti-SARS-CoV-2 antibody responses. Conclusion: This new SLR confirms that some immunomodulators (tocilizumab and JAK inhibitors) have a role for treating severe and critical COVID-19. Although better evidence is available compared with the previous SLR, the need of RCT with combination therapy (glucocorticoids+anti-cytokines) versus monotherapy with glucocorticoids still remains alongside the need for standardisation of inclusion criteria and outcomes to ultimately improve the care and prognosis of affected people. This SLR informed the 2021 update of the EULAR points to consider on the use of immunomodulatory therapies in COVID-19.

• Item Type: Articles
• Additional Information: Funding: This work was funded by the European Alliance of Associations for Rheumatology (EULAR), formerly the European League Against Rheumatism (CLI122). PMM is supported by the National Institute for Health Research (NIHR) University College London Hospitals (UCLH) Biomedical Research Centre (BRC).
• Status: Published
• Refereed: Yes
• Glasgow Author(s) Enlighten ID: Najm, Dr Aurelie
• Authors: Alunno, A., Najm, A., Mariette, X., De Marco, G., Emmel, J., Mason, L., McGonagle, D. G., and Machado, P. M.
• College/School: College of Medical Veterinary and Life Sciences > School of Infection & Immunity
• Research Centre: College of Medical Veterinary and Life Sciences > School of Infection & Immunity > Centre for Immunobiology
• Journal Name: RMD Open
• Publisher: BMJ Publishing Group
• ISSN: 2056-5933
• Published Online: 01 November 2021
• Copyright Holders: Copyright © Author(s) (or their employer(s)) 2021
• First Published: First published in RMD Open 7: e001899
• Publisher Policy: Reproduced under a Creative Commons licence