PT  - JOURNAL ARTICLE
AU  - Alessia Alunno
AU  - Aurélie Najm
AU  - Pedro M Machado
AU  - Heidi Bertheussen
AU  - Gerd-Rüdiger 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 B McInnes
AU  - Pier Luigi Meroni
AU  - Luca Quartuccio
AU  - A 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
TI  - 2021 update of the EULAR points to consider on the use of immunomodulatory therapies in COVID-19
AID  - 10.1136/annrheumdis-2021-221366
DP  - 2021 Oct 07
TA  - Annals of the Rheumatic Diseases
PG  - annrheumdis-2021-221366
4099  - http://ard.bmj.com/content/early/2021/10/06/annrheumdis-2021-221366.short
4100  - http://ard.bmj.com/content/early/2021/10/06/annrheumdis-2021-221366.full
AB  - Objectives To update the EULAR points to consider (PtCs) on the use of immunomodulatory therapies in COVID-19.Methods According to the EULAR standardised operating procedures, a systematic literature review up to 14 July 2021 was conducted and followed by a consensus meeting of an international multidisciplinary task force. The new statements were consolidated by formal voting.Results We updated 2 overarching principles and 12 PtC. Evidence was only available in moderate to severe and critical patients. Glucocorticoids alone or in combination with tocilizumab are beneficial in COVID-19 cases requiring oxygen therapy and in critical COVID-19. Use of Janus kinase inhibitors (baricitinib and tofacitinib) is promising in the same populations of severe and critical COVID-19. Anti-SARS-CoV-2 monoclonal antibodies and convalescent plasma may find application in early phases of the disease and in selected subgroups of immunosuppressed patients. There was insufficient robust evidence for the efficacy of other immunomodulators with further work being needed in relation to biomarker-based stratification for IL-1 therapyConclusions Growing evidence supports incremental efficacy of glucocorticoids alone or combined with tocilizumab/Janus kinase inhibitors in moderate to severe and critical COVID-19. Ongoing studies may unmask the potential application of other therapeutic approaches. Involvement of rheumatologists, as systemic inflammatory diseases experts, should be encouraged in clinical trials of immunomodulatory therapy in COVID-19.Data sharing not applicable as no datasets generated and/or analysed for this study. All data relevant to the study are included in the article or uploaded as online supplemental information.