TY - JOUR T1 - EULAR points to consider on pathophysiology and use of immunomodulatory therapies in COVID-19 JF - Annals of the Rheumatic Diseases JO - Ann Rheum Dis DO - 10.1136/annrheumdis-2020-219724 SP - annrheumdis-2020-219724 AU - Alessia Alunno AU - Aurélie Najm AU - Pedro M Machado AU - Heidi Bertheussen AU - Gerd R Burmester AU - Francesco Carubbi AU - Gabriele De Marco AU - Roberto Giacomelli AU - Olivier Hermine AU - John D Isaacs AU - Isabelle Koné-Paut AU - César Magro-Checa AU - Iain McInnes AU - Pier Luigi Meroni AU - Luca Quartuccio AU - Athimalaipet V Ramanan AU - Manuel Ramos-Casals AU - Javier Rodríguez Carrio AU - Hendrik Schulze-Koops AU - Tanja A Stamm AU - Sander W Tas AU - Benjamin Terrier AU - Dennis G McGonagle AU - Xavier Mariette Y1 - 2021/02/05 UR - http://ard.bmj.com/content/early/2021/02/05/annrheumdis-2020-219724.abstract N2 - 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. ER -