The use of anti-inflammatory drugs in the treatment of people with severe coronavirus disease 2019 (COVID-19): The Perspectives of clinical immunologists from China

Wen Zhang, Yan Zhao, Fengchun Zhang, Qian Wang, Taisheng Li, Zhengyin Liu, Jinglan Wang, Yan Qin, Xuan Zhang, Xiaowei Yan, Xiaofeng Zeng, Shuyang Zhang, Wen Zhang, Yan Zhao, Fengchun Zhang, Qian Wang, Taisheng Li, Zhengyin Liu, Jinglan Wang, Yan Qin, Xuan Zhang, Xiaowei Yan, Xiaofeng Zeng, Shuyang Zhang

Abstract

The pandemic outbreak of coronavirus disease 2019 (COVID-19) is rapidly spreading all over the world. Reports from China showed that about 20% of patients developed severe disease, resulting in a fatality of 4%. In the past two months, we clinical immunologists participated in multi-rounds of MDT (multidiscipline team) discussion on the anti-inflammation management of critical COVID-19 patients, with our colleagues dispatched from Chinese leading PUMC Hospital to Wuhan to admit and treat the most severe patients. Here, from the perspective of clinical immunologists, we will discuss the clinical and immunological characteristics of severe patients, and summarize the current evidence and share our experience in anti-inflammation treatment, including glucocorticoids, IL-6 antagonist, JAK inhibitors and choloroquine/hydrocholoroquine, of patients with severe COVID-19 that may have an impaired immune system.

Keywords: Anti-inflammation treatment; Coronavirus disease 2019 (COVID-19); Cytokine storm.

Conflict of interest statement

Declaration of Competing Interest None.

Copyright © 2020 Elsevier Inc. All rights reserved.

References

    1. Channappanavar R., Perlman S. Pathogenic human coronavirus infections: causes and consequences of cytokine storm and immunopathology. Semin. Immunopathol. 2017;39:529–539.
    1. Chousterman B.G., Swirski F.K., Weber G.F. Cytokine storm and sepsis disease pathogenesis. Semin. Immunopathol. 2017;39:517–528.
    1. Huang C., Wang Y., Li X., Ren L., Zhao J., Hu Y. Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China. Lancet. 2020;395:497–506.
    1. Conti P., Ronconi G., Caraffa A., Gallenga C.E., Ross R., Frydas I. Induction of pro-inflammatory cytokines (IL-1 and IL-6) and lung inflammation by Coronavirus-19 (COVI-19 or SARS-CoV-2): anti-inflammatory strategies. J. Biol. Regul. Homeost. Agents. 2020;34 doi: 10.23812/CONTI-E.
    1. Zhou F., Yu T., Du R., Fan G., Liu Y., Liu Z. Clinical course and risk factors for mortality of adult inpatients with COVID-19 in Wuhan, China: a retrospective cohort study. Lancet. 2020 doi: 10.1016/s0140-6736(20)30566-3.
    1. Ruan Q., Yang K., Wang W., Jiang L., Song J. Clinical predictors of mortality due to COVID-19 based on an analysis of data of 150 patients from Wuhan, China. Intensive Care Med. 2020 doi: 10.1007/s00134-020-05991-x. Mar 3.
    1. Chen N., Zhou M., Dong X., Qu J., Gong F., Han Y. Epidemiological and clinical characteristics of 99 cases of 2019 novel coronavirus pneumonia in Wuhan, China: a descriptive study. Lancet. 2020;395:507–513.
    1. Wu C., Chen X., Cai Y., Xia J., Zhou X., Xu S. Risk factors associated with acute respiratory distress syndrome and death in patients with coronavirus disease 2019 pneumonia in Wuhan, China. JAMA Intern. Med. 2020 doi: 10.1001/jamainternmed.2020.0994.
    1. Wan S., Yi Q., Fan S., Lv J., Zhang X., Guo L. Characteristics of lymphocyte subsets and cytokines in peripheral blood of 123 hospitalized patients with 2019 novel coronavirus pneumonia (NCP) medRxiv. 2020
    1. Xu Z., Shi L., Wang Y., Zhang J., Huang L., Zhang C. Pathological findings of COVID-19 associated with acute respiratory distress syndrome. Lancet Respir. Med. 2020 doi: 10.1016/S2213-2600(20)30076-X.
    1. Siddiqi H.K., Mehra M.R. COVID-19 illness in native and immunosuppressed states: a clinical-therapeutic staging proposal. J. Heart Lung Transplant. 2020
    1. National Health Commission of the People's Republic of China The Diagnosis and Treatment Plan for 2019-nCoV (The Seventh Trial Edition) (accessed 4 March 2020)
    1. Qin C., Zhou L., Hu Z., Zhang S., Yang S., Tao Y. Dysregulation of immune response in patients with COVID-19 in Wuhan, China. Clin. Infect. Dis. 2020 doi: 10.1093/cid/ciaa248.
    1. Yao X.H., Li T.Y., He Z.C., Ping Y.F., Liu H.W., Yu S.C. A pathological report of three COVID-19 cases by minimally invasive autopsies. Chin. J. Pathol. 2020;49 doi: 10.3760/cma.j.cn112151-20200312-00193.
    1. Guo X., Thomas P. New fronts emerge in the influenza cytokine storm. Semin. Immunopathol. 2017;39:541–550.
    1. Shimabukuro-Vornhagen A., Gödel P., Subklewe M., Stemmler H.J., Schlößer H.A., Schlaak M. Cytokine release syndrome. J. Immunother. Cancer. 2018;6:56.
    1. Chen C., Zhang X.R., Ju Z.Y., He W.F. Advances in the research of cytokine storm mechanism induced by Corona virus disease 2019 and the corresponding immunotherapies. Chin. J. Burns. 2020;36 doi: 10.3760/cma.j.cn501120-20200224-00088.
    1. Auyeung T.W., Lee J.S., Lai W.K., Choi C.H., Lee H.K., Lee J.S. The use of corticosteroid as treatment in SARS was associated with adverse outcomes: a retrospective cohort study. J. Inf. Secur. 2005;51:98–102.
    1. Ho J.C., Ooi G.C., Mok T.Y., Chan J.W., Hung I., Lam B. High-dose pulse versus nonpulse corticosteroid regimens in severe acute respiratory syndrome. Am. J. Respir. Crit. Care Med. 2003;168:1449–1456.
    1. Yam L.Y., Lau A.C., Lai F.Y., Shung E., Chan J., Wong V. Corticosteroid treatment of severe acute respiratory syndrome in Hong Kong. J. Inf. Secur. 2007;54:28–39.
    1. Chen R.C., Tang X.P., Tan S.Y., Liang B.L., Wan Z.Y., Fang J.Q. Treatment of severe acute respiratory syndrome with glucosteroids: the Guangzhou experience. Chest. 2006;129:1441–1452.
    1. Rhodes A., Evans L.E., Alhazzani W., Levy M.M., Antonelli M., Ferrer R., Kumar A. Surviving sepsis campaign: international guidelines for management of sepsis and septic shock: 2016. Intensive Care Med. 2017;43:304–377.
    1. Sun P., Lu X., Xu C., Sun W., Pan B. Understanding of COVID-19 based on current evidence. J. Med. Virol. 2020 doi: 10.1002/jmv.25722.
    1. Chan K.W., Wong V.T., Tang S.C.W. COVID-19: an update on the epidemiological, clinical, preventive and therapeutic evidence and guidelines of integrative Chinese-Western medicine for the management of 2019 novel coronavirus disease. Am. J. Chin. Med. 2020:1–26.
    1. Chen N., Zhou M., Dong X., Qu J., Gong F., Han Y. Epidemiological and clinical characteristics of 99 cases of 2019 novel coronavirus pneumonia in Wuhan, China: a descriptive study. Lancet. 2020;395:507–513.
    1. Wang D., Hu B., Hu C., Zhu F., Liu X., Zhang J. Clinical characteristics of 138 hospitalized patients with 2019 Novel Coronavirus-infected pneumonia in Wuhan, China. JAMA. 2020 doi: 10.1001/jama.2020.1585.
    1. Russell C.D., Millar J.E., Baillie J.K. Clinical evidence does not support corticosteroid treatment for 2019-nCoV lung injury. Lancet. 2020;395:473–475.
    1. World Health Organization Clinical Management of Severe Acute Respiratory Infection when Novel Coronavirus (nCoV) Infection is Suspected. (accessed 28 January 2020)
    1. Richardson P., Griffin I., Tucker C., Smith D., Oechsle O., Phelan A., Stebbing J. Baricitinib as potential treatment for 2019-nCoV acute respiratory disease. Lancet. 2020;395:e30–e31.
    1. Lajoie J., Mwangi L., Fowke K.R. Preventing HIV infection without targeting the virus: how reducing HIV target cells at the genital tract is a new approach to HIV prevention. AIDS Res. Ther. 2017;14:46.
    1. Kumar A., Liang B., Aarthy M., Singh S.K., Garg N., Mysorekar I.U., Giri R. Hydroxychloroquine inhibits Zika virus NS2B-NS3 protease. ACS Omega. 2018;3:18132–18141.
    1. Wang L.F., Lin Y.S., Huang N.C., Yu C.Y., Tsai W.L., Chen J.J. Hydroxychloroquine-inhibited dengue virus is associated with host defense machinery. J. Interf. Cytokine Res. 2015;35:143–156.
    1. Akpovwa H. Chloroquine could be used for the treatment of filoviral infections and other viral infections that emerge or emerged from viruses requiring an acidic pH for infectivity. Cell Biochem. Funct. 2016;34:191–196.
    1. Barnard D.L., Day C.W., Bailey K., Heiner M., Montgomery R., Lauridsen L. Evaluation of immunomodulators, interferons and known in vitro SARS-coV inhibitors for inhibition of SARS-coV replication in BALB/c mice. Antivir. Chem. Chemother. 2006;17:275–284.
    1. Vincent M.J., Bergeron E., Benjannet S., Erickson B.R., Rollin P.E., Ksiazek T.G. Chloroquine is a potent inhibitor of SARS coronavirus infection and spread. Virol. J. 2005;2:69.
    1. Randolph V.B., Winkler G., Stollar V. Acidotropic amines inhibit proteolytic processing of flavivirus prM protein. Virology. 1990;174:450–458.
    1. Wang M., Cao R., Zhang L., Yang X., Liu J., Xu M. Remdesivir and chloroquine effectively inhibit the recently emerged novel coronavirus (2019-nCoV) in vitro. Cell Res. 2020;30:269–271.
    1. Zhang Q., Wang Y., Qi C., Shen L., Li J. Clinical trial analysis of 2019-nCoV therapy registered in China. J. Med. Virol. 2020 doi: 10.1002/jmv.25733.
    1. Dong L., Hu S., Gao J. Discovering drugs to treat coronavirus disease 2019 (COVID-19) Drug Discov. Ther. 2020;14:58–60.

Source: PubMed

Patrocinadores y Colaboradores

Condiciones médicas

Intervenciones de drogas

3
Suscribir