Department of Clinical Therapeutics, National and Kapodistrian University of Athens Medical School, Athens, Greece.
Joint Rheumatology Program, First Department of Propaedeutic Internal Medicine, National and Kapodistrian University of Athens Medical School, 17 Agiou Thoma Street, 11527, Athens, Greece.
Rheumatol Int. 2020 Sep;40(9):1353-1360. doi: 10.1007/s00296-020-04629-x. Epub 2020 Jul 11.
As of June 10th 2020 about 7.2 million individuals have tested positive for, and more than 410,000 have died due to COVID-19. In this review we outline the pathophysiology that underpins the potential use of anti-rheumatic therapies for severe COVID-19 infection and summarize the current evidence regarding the risk and outcome of COVID-19 in patients with systemic autoimmune diseases. Thus far there is no convincing evidence that any disease-modifying anti-rheumatic drug (conventional synthetic, biologic or targeted synthetic) including hydroxychloroquine, may protect against severe COVID-19 infection; answers about their possible usefulness in the management of the cytokine storm associated with severe COVID-9 infection will only arise from ongoing randomized controlled trials. Evidence on COVID-19 risk and outcome in patients with systemic autoimmune diseases is extremely limited; thus, any conclusions would be unsafe and should be seen with great caution. At present, the risk and severity (hospitalization, intensive care unit admission and death) of COVID-19 infection in people with autoimmune diseases do not appear particularly dissimilar to the general population, with the possible exception of hospitalization in patients exposed to high glucocorticoid doses. At this stage it is impossible to draw any conclusions for differences in COVID-19 risk and outcome between different autoimmune diseases and between the various immunomodulatory therapies used for them. More research in the field is obviously required, including as a minimum careful and systematic epidemiology and appropriately controlled clinical trials.
截至 2020 年 6 月 10 日，约有 720 万人检测出 COVID-19 呈阳性，超过 41 万人死于 COVID-19。在这篇综述中，我们概述了支持抗风湿疗法在严重 COVID-19 感染中应用的病理生理学基础，并总结了目前关于系统性自身免疫性疾病患者 COVID-19 风险和结局的证据。到目前为止，没有令人信服的证据表明任何疾病修饰抗风湿药物（传统合成、生物或靶向合成），包括羟氯喹，可能预防严重的 COVID-19 感染；关于它们在严重 COVID-9 感染相关细胞因子风暴管理中的可能有用性的答案，只有来自正在进行的随机对照试验。关于系统性自身免疫性疾病患者 COVID-19 风险和结局的证据极其有限；因此，任何结论都是不安全的，应该非常谨慎地看待。目前，自身免疫性疾病患者 COVID-19 感染的风险和严重程度（住院、入住重症监护病房和死亡）似乎与一般人群没有特别不同，可能除了暴露于高剂量糖皮质激素的患者住院治疗外。在现阶段，不可能得出任何关于不同自身免疫性疾病之间以及用于治疗这些疾病的各种免疫调节疗法之间 COVID-19 风险和结局差异的结论。显然需要在该领域进行更多的研究，包括最低限度的仔细和系统的流行病学和适当控制的临床试验。
