RT Journal Article
SR Electronic
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
FD BMJ Publishing Group Ltd and European League Against Rheumatism
SP 698
OP 706
DO 10.1136/annrheumdis-2020-219724
VO 80
IS 6
A1 Alessia Alunno
A1 Aurélie Najm
A1 Pedro M Machado
A1 Heidi Bertheussen
A1 Gerd R Burmester
A1 Francesco Carubbi
A1 Gabriele De Marco
A1 Roberto Giacomelli
A1 Olivier Hermine
A1 John D Isaacs
A1 Isabelle Koné-Paut
A1 César Magro-Checa
A1 Iain McInnes
A1 Pier Luigi Meroni
A1 Luca Quartuccio
A1 Athimalaipet V Ramanan
A1 Manuel Ramos-Casals
A1 Javier Rodríguez Carrio
A1 Hendrik Schulze-Koops
A1 Tanja A Stamm
A1 Sander W Tas
A1 Benjamin Terrier
A1 Dennis G McGonagle
A1 Xavier Mariette
YR 2021
UL http://ard.bmj.com/content/80/6/698.abstract
AB 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.