Hamilton College

New treatment strategies in addition to antiviral therapy has potential to significantly improve clinical outcome. One of those new potential treatments is immunomodulatory therapy. Immunomodulatory agents for the reduction of cytokine storms combined with antiviral agents could aid in the treatment process. 

- Corticosteroids
- Chloroquine
- Tocilizumab
- Proposed Doses for COVID-19 Immunomodulatory Therapy 

Immunomodulatory Therapy for the Reduction of Cytokine Storms and COVID-19 Treatment

Zhao, M. (2020). Cytokine storm and immunomodulatory therapy in COVID-19: role of chloroquine and anti-IL-6 monoclonal antibodies. International journal of antimicrobial agents. doi: 10.1016/j.ijantimicag.2020.105982 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7161506/

Cytokine Storm and Immunomodulatory therapy in COVID-19: Role of Chloroquine and Anti-IL-6 Monoclonal Antibodies

The most commonly used drugs for immunomodulatory therapy are corticosteroids, which in COVID-19 patients can suppress the host immune system and delay viral clearance. Through the findings of two recent patient studies, it is now believed that corticosteroid usage is beneficial in severe cases of COVID-19 (particularly in patients with ARDS), not in patients with mild cases of COVID-19. Therefore, corticosteroids are only recommended for patients in critical conditions. 

The decision must still be made carefully even in critical cases of COVID-19 due to their potential negative side effects. There is no available data illustrating the success of corticosteroids in SARS-CoV or MERS. 

Corticosteroids and COVID-19

Chloroquine, and hydroxychloroquine, have become recent treatments for COVID-19, and as of June 2020, chloroquine appears to be effective in the limitation of SARS-CoV-2 reproduction in vitro. A study from February 2020 showed good efficacy from chloroquine phosphate in over 100 Chinese patients. French doctors also identified relatively good efficacy in 20 COVID-19 patients who received hydroxychloroquine.  

The major treatments studied so far include: chloroquine phosphate, hydroxychloroquine sulfate, and carrimycin (all varying in dosage and delivery system). However, more data (particularly safety data) from high-quality clinical trials is still needed. 

Chloroquine and COVID-19

Immunomodulatory agents which directly targets cytokines involved in COVID-19 also have the potential to lower hyperinflammation in severe cases, which is important when elevated levels of IL6 in the blood has proved to be a predictor for fatal outcomes in COVID-19 patients. Tocilizumab, an antibody which blocks IL6 has been recommended for patients with severe or critical illness, extensive lesions in bilateral lungs, and confirmed elevated levels of IL6. A study on 20 patients with severe COVID-19 illustrated reduction in fever and lung lesion opacity and recovery of percentage of peripheral blood lymphocytes after treatment with tocilizumab. 

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