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Immune-Based Therapy Under Evaluation for Treatment of COVID-19

Last Updated: July 17, 2020

Given the hyperactive inflammatory effects of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), agents that modulate the immune response are being explored as adjunctive treatments for the management of moderate to critical COVID-19.1 These agents include human blood-derived products and immunomodulatory therapies.

Some human blood-derived products are obtained from individuals who have recovered from SARS-CoV-2 infection (e.g., convalescent plasma, immunoglobulin products).2,3 These heterogenous products are postulated to have either direct antiviral properties, such as with convalescent plasma, and/or immunomodulatory effects like those noted with mesenchymal stem cells.4 Additionally, neutralizing monoclonal antibodies directed against SARS-CoV-2 have been developed and are under investigation in clinical trials.5

Other agents in this group include therapeutics currently approved for the treatment of other immune and/or inflammatory syndromes. These agents include corticosteroids (e.g., glucocorticoids),6 which as a class possess a broad array of mechanisms to abrogate systemic inflammation, and more targeted anti-inflammatory treatments such as interleukin inhibitors,7,8 interferons,9 kinase inhibitors,10 and others.

In the following sections of the COVID-19 Treatment Guidelines, different blood-derived products and immunomodulators under investigation for the management of COVID-19 are discussed. Items discussed include the proposed rationale for use of these therapies, the clinical safety and efficacy data to date, and the COVID-19 Treatment Guidelines Panel’s recommendations for their use.

References

  1. Zhong J, Tang J, Ye C, Dong L. The immunology of COVID-19: is immune modulation an option for treatment? Lancet Rheumatology. 2020;2(7):e438-e436. Available at: https://www.thelancet.com/journals/lanrhe/article/PIIS2665-9913(20)30120-X/fulltext#seccestitle10.
  2. Wang X, Guo X, Xin Q, et al. Neutralizing antibodies responses to SARS-CoV-2 in COVID-19 inpatients and convalescent patients. medRxiv. 2020;Preprint. Available at: https://www.medrxiv.org/content/10.1101/2020.04.15.20065623v3.
  3. Mair-Jenkins J, Saavedra-Campos M, Baillie JK, et al. The effectiveness of convalescent plasma and hyperimmune immunoglobulin for the treatment of severe acute respiratory infections of viral etiology: a systematic review and exploratory meta-analysis. J Infect Dis. 2015;211(1):80-90. Available at: https://www.ncbi.nlm.nih.gov/pubmed/25030060.
  4. Shetty AK. Mesenchymal Stem Cell Infusion Shows Promise for Combating Coronavirus (COVID-19)- Induced Pneumonia. Aging Dis. 2020;11(2):462-464. Available at: https://www.ncbi.nlm.nih.gov/pubmed/32257554.
  5. Marovich M, Mascola JR, Cohen MS. Monoclonal antibodies for prevention and treatment of COVID-19. JAMA. 2020. Available at: https://www.ncbi.nlm.nih.gov/pubmed/32539093.
  6. Horby P, Shen Lim W, Emberson J, et al. Effect of dexamethasone in hospitalized patients with COVID-19: preliminary report. medRxiv. 2020;Preprint. Available at: https://www.medrxiv.org/content/10.1101/2020.06.22.20137273v1.
  7. Shakoory B, Carcillo JA, Chatham WW, et al. Interleukin-1 receptor blockade is associated with reduced mortality in sepsis patients with features of macrophage activation syndrome: reanalysis of a prior Phase III trial. Crit Care Med. 2016;44(2):275-281. Available at: https://www.ncbi.nlm.nih.gov/pubmed/26584195.
  8. Xu X, Han M, Li T, et al. Effective treatment of severe COVID-19 patients with tocilizumab. Proc Natl Acad Sci USA. 2020. Available at: https://www.ncbi.nlm.nih.gov/pubmed/32350134.
  9. Zhou Q, Wei X, Xiang X, et al. Interferon-a2b treatment for COVID-19. medRxiv. 2020;Preprint. Available at: https://www.medrxiv.org/content/10.1101/2020.04.06.20042580v1.
  10. Cao Y, Wei J, Zou L, et al. Ruxolitinib in treatment of severe coronavirus disease 2019 (COVID-19): a multicenter, single-blind, randomized controlled trial. J Allergy Clin Immunol. 2020;146(1):137-146. Available at: https://www.ncbi.nlm.nih.gov/pubmed/32470486.