Nissen Christoffer B, Sciascia Savino, de Andrade Danieli, Atsumi Tatsuya, Bruce Ian N, Cron Randy Q, Hendricks Oliver, Roccatello Dario, Stach Ksenija, Trunfio Mattia, Vinet Évelyne, Schreiber Karen
Danish Hospital for Rheumatic Diseases, University of Southern Denmark, Sønderborg, Danmark.
Center of Research of Immunopathology and Rare Diseases, Coordinating Center of Piemonte and Aosta Valley Network for Rare Diseases, Nephrology and Dialysis, Department of Clinical and Biological Sciences, University of Turin, Italy.
Lancet Rheumatol. 2021 Jun;3(6):e447-e459. doi: 10.1016/S2665-9913(21)00062-X. Epub 2021 Mar 30.
The COVID-19 pandemic has resulted in more than 2 million deaths globally. Two interconnected stages of disease are generally recognised; an initial viral stage and a subsequent immune response phase with the clinical characteristics of hyperinflammation associated with acute respiratory distress syndrome. Therefore, many immune modulators and immunosuppressive drugs, which are widely used in rheumatological practice, have been proposed as treatments for patients with moderate or severe COVID-19. In this Review, we provide an overview of what is currently known about the efficacy and safety of antirheumatic therapies for the treatment of patients with COVID-19. Dexamethasone has been shown to reduce COVID-19 related mortality, interleukin-6 inhibitors to reduce risk of cardiovascular or respiratory organ support, and baricitinib to reduce time to recovery in hospitalised patients requiring oxygen support. Further studies are needed to identify whether there is any role for glucocorticoids in patients with less severe COVID-19. Although evidence on the use of other antirheumatic drugs has suggested some benefits, results from adequately powered clinical trials are urgently needed. The heterogeneity in dosing and the absence of uniform inclusion criteria and defined stage of disease studied in many clinical trials have affected the conclusions and comparability of trial results. However, after the success of dexamethasone in proving the anti-inflammatory hypothesis, the next 12 months will undoubtedly bring further clarity about the clinical utility and optimal dose and timing of other anti-rheumatic drugs in the management of COVID-19.
新冠疫情已导致全球超过200万人死亡。疾病通常分为两个相互关联的阶段：初始的病毒阶段和随后的免疫反应阶段，其临床特征为与急性呼吸窘迫综合征相关的过度炎症。因此，许多在风湿病治疗中广泛使用的免疫调节剂和免疫抑制药物已被提议用于治疗中度或重度新冠肺炎患者。在本综述中，我们概述了目前已知的抗风湿疗法治疗新冠肺炎患者的疗效和安全性。地塞米松已被证明可降低新冠肺炎相关死亡率，白细胞介素-6抑制剂可降低心血管或呼吸器官支持的风险，巴瑞替尼可缩短需要氧气支持的住院患者的康复时间。需要进一步研究以确定糖皮质激素在病情较轻的新冠肺炎患者中是否有作用。尽管关于使用其他抗风湿药物的证据表明有一些益处，但迫切需要有足够样本量的临床试验结果。许多临床试验中给药的异质性以及缺乏统一的纳入标准和明确的疾病研究阶段，影响了试验结果的结论和可比性。然而，在地塞米松成功证明抗炎假说之后，未来12个月无疑将进一步明确其他抗风湿药物在新冠肺炎治疗中的临床效用以及最佳剂量和时机。
