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

Alunno, A. et al. (2021) EULAR points to consider on pathophysiology and use of immunomodulatory therapies in COVID-19. Annals of the Rheumatic Diseases, 80(6), pp. 698-706. (doi: 10.1136/annrheumdis-2020-219724) (PMID:33547062) (PMCID:PMC7871226)

Abstract

Objectives: Severe systemic inflammation associated with some stages of COVID-19 and in fatal cases led therapeutic agents developed or used frequently in Rheumatology being at the vanguard of experimental therapeutics strategies. The aim of this project was to elaborate EULAR Points to consider (PtCs) on COVID-19 pathophysiology and immunomodulatory therapies. Methods: PtCs were developed in accordance with EULAR standard operating procedures for endorsed recommendations, led by an international multidisciplinary Task Force, including rheumatologists, translational immunologists, haematologists, paediatricians, patients and health professionals, based on a systemic literature review up to 15 December 2020. Overarching principles (OPs) and PtCs were formulated and consolidated by formal voting. Results: Two OPs and fourteen PtCs were developed. OPs highlight the heterogeneous clinical spectrum of SARS-CoV-2 infection and the need of a multifaceted approach to target the different pathophysiological mechanisms. PtCs 1–6 encompass the pathophysiology of SARS-CoV-2 including immune response, endothelial dysfunction and biomarkers. PtCs 7–14 focus on the management of SARS-CoV-2 infection with immunomodulators. There was evidence supporting the use of glucocorticoids, especially dexamethasone, in COVID-19 cases requiring oxygen therapy. No other immunomodulator demonstrated efficacy on mortality to date, with however inconsistent results for tocilizumab. Immunomodulatory therapy was not associated with higher infection rates. Conclusions: Multifactorial pathophysiological mechanisms, including immune abnormalities, play a key role in COVID-19. The efficacy of glucocorticoids in cases requiring oxygen therapy suggests that immunomodulatory treatment might be effective in COVID-19 subsets. Involvement of rheumatologists, as systemic inflammatory diseases experts, should continue in ongoing clinical trials delineating optimal immunomodulatory therapy utilisation in COVID-19.

• Item Type: Articles
• Status: Published
• Refereed: Yes
• Glasgow Author(s) Enlighten ID: McInnes, Professor Iain and Najm, Dr Aurelie
• Authors: Alunno, A., Najm, A., Machado, P. M., Bertheussen, H., Burmester, G. R., Carubbi, F., De Marco, G., Giacomelli, R., Hermine, O., Isaacs, J. D., Koné-Paut, I., Magro-Checa, C., McInnes, I., Meroni, P. L., Quartuccio, L., Ramanan, A. V., Ramos-Casals, M., Rodríguez Carrio, J., Schulze-Koops, H., Stamm, T. A., Tas, S. W., Terrier, B., McGonagle, D. G., and Mariette, X.
• 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: Annals of the Rheumatic Diseases
• Publisher: BMJ Publishing Group
• ISSN: 0003-4967
• ISSN (Online): 1468-2060
• Published Online: 05 February 2021
• Copyright Holders: Copyright © 2021 The Authors
• First Published: First published in Annals of the Rheumatic Diseases 80(6): 698-706
• Publisher Policy: Reproduced under a Creative Commons License