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Immunomodulation as Treatment for Severe Coronavirus Disease 2019: A Systematic Review of Current Modalities and Future Directions

In severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection, viral load peaks early and declines quickly after symptom onset. Severe coronavirus disease 2019 (COVID-19) is marked by aberrant innate and adaptive immune responses with an abnormal cytokine profile and multiorgan system dy...

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Autores principales: Meyerowitz, Eric A, Sen, Pritha, Schoenfeld, Sara R, Neilan, Tomas G, Frigault, Matthew J, Stone, John H, Kim, Arthur Y, Mansour, Michael K
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Oxford University Press 2020
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7717185/
https://www.ncbi.nlm.nih.gov/pubmed/33216852
http://dx.doi.org/10.1093/cid/ciaa1759
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author Meyerowitz, Eric A
Sen, Pritha
Schoenfeld, Sara R
Neilan, Tomas G
Frigault, Matthew J
Stone, John H
Kim, Arthur Y
Mansour, Michael K
author_facet Meyerowitz, Eric A
Sen, Pritha
Schoenfeld, Sara R
Neilan, Tomas G
Frigault, Matthew J
Stone, John H
Kim, Arthur Y
Mansour, Michael K
author_sort Meyerowitz, Eric A
collection PubMed
description In severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection, viral load peaks early and declines quickly after symptom onset. Severe coronavirus disease 2019 (COVID-19) is marked by aberrant innate and adaptive immune responses with an abnormal cytokine profile and multiorgan system dysfunction that persists well after viral clearance. A purely antiviral treatment strategy may therefore be insufficient, and antiviral agents have not shown a benefit later in the illness course. A number of immunomodulatory strategies are being tested, including corticosteroids, cytokine and anticytokine therapies, small molecule inhibitors, and cellular therapeutics. To date, the only drug to show a mortality benefit for COVID-19 in a randomized, controlled trial is dexamethasone. However, there remains uncertainty about which patients may benefit most and about longer-term complications, including secondary infections. Here, we review the immune dysregulation of severe COVID-19 and the existing data behind various immunomodulatory strategies, and we consider future directions of study.
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spelling pubmed-77171852020-12-09 Immunomodulation as Treatment for Severe Coronavirus Disease 2019: A Systematic Review of Current Modalities and Future Directions Meyerowitz, Eric A Sen, Pritha Schoenfeld, Sara R Neilan, Tomas G Frigault, Matthew J Stone, John H Kim, Arthur Y Mansour, Michael K Clin Infect Dis Online Only Articles In severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection, viral load peaks early and declines quickly after symptom onset. Severe coronavirus disease 2019 (COVID-19) is marked by aberrant innate and adaptive immune responses with an abnormal cytokine profile and multiorgan system dysfunction that persists well after viral clearance. A purely antiviral treatment strategy may therefore be insufficient, and antiviral agents have not shown a benefit later in the illness course. A number of immunomodulatory strategies are being tested, including corticosteroids, cytokine and anticytokine therapies, small molecule inhibitors, and cellular therapeutics. To date, the only drug to show a mortality benefit for COVID-19 in a randomized, controlled trial is dexamethasone. However, there remains uncertainty about which patients may benefit most and about longer-term complications, including secondary infections. Here, we review the immune dysregulation of severe COVID-19 and the existing data behind various immunomodulatory strategies, and we consider future directions of study. Oxford University Press 2020-11-20 /pmc/articles/PMC7717185/ /pubmed/33216852 http://dx.doi.org/10.1093/cid/ciaa1759 Text en © The Author(s) 2020. Published by Oxford University Press for the Infectious Diseases Society of America. All rights reserved. For permissions, e-mail: journals.permissions@oup.com. https://academic.oup.com/journals/pages/open_access/funder_policies/chorus/standard_publication_modelThis article is published and distributed under the terms of the Oxford University Press, Standard Journals Publication Model (https://academic.oup.com/journals/pages/open_access/funder_policies/chorus/standard_publication_model)
spellingShingle Online Only Articles
Meyerowitz, Eric A
Sen, Pritha
Schoenfeld, Sara R
Neilan, Tomas G
Frigault, Matthew J
Stone, John H
Kim, Arthur Y
Mansour, Michael K
Immunomodulation as Treatment for Severe Coronavirus Disease 2019: A Systematic Review of Current Modalities and Future Directions
title Immunomodulation as Treatment for Severe Coronavirus Disease 2019: A Systematic Review of Current Modalities and Future Directions
title_full Immunomodulation as Treatment for Severe Coronavirus Disease 2019: A Systematic Review of Current Modalities and Future Directions
title_fullStr Immunomodulation as Treatment for Severe Coronavirus Disease 2019: A Systematic Review of Current Modalities and Future Directions
title_full_unstemmed Immunomodulation as Treatment for Severe Coronavirus Disease 2019: A Systematic Review of Current Modalities and Future Directions
title_short Immunomodulation as Treatment for Severe Coronavirus Disease 2019: A Systematic Review of Current Modalities and Future Directions
title_sort immunomodulation as treatment for severe coronavirus disease 2019: a systematic review of current modalities and future directions
topic Online Only Articles
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7717185/
https://www.ncbi.nlm.nih.gov/pubmed/33216852
http://dx.doi.org/10.1093/cid/ciaa1759
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