Hornuss Daniel, Giesen Roland, Biever Paul, Kern Winfried V
Klinik für Innere Medizin II - Gastroenterologie, Hepatologie, Endokrinologie, Infektiologie, Universitätsklinikum Freiburg, Medizinische Fakultät, Albert-Ludwigs-Universität Freiburg.
Klinik für Kardiologie I - Universitäts-Herzzentrum Freiburg-Bad Krozingen, Universitätsklinikum Freiburg, Medizinische Fakultät, Albert-Ludwigs-Universität Freiburg.
Dtsch Med Wochenschr. 2021 Nov;146(23):1538-1542. doi: 10.1055/a-1643-4209. Epub 2021 Nov 26.
The pathophysiological course of COVID-19 can be distinguished in a phase of viral replication and an inflammatory phase. Hyperinflammatory processes promote the development of severe COVID-19. Therefore, immunomodulating agents came into focus. Dexamethasone has already become standard of care for treatment of severe COVID-19. Two large randomized trials and a meta-analysis of collectively nine randomized trials showed a reduced mortality in patients with severe COVID-19 if Tocilizumab - an IL-6-rezeptor antagonist - was added to standard of care. Treatment with Baricitinib - a JAK 1/2 inhibitor - may also be beneficial for patients without or on low oxygen supplementation. National and international guidelines recommend Tocilizumab for treatment of severe COVID-19. Treatment with JAK inhibitors is an option for hospitalized patients with moderate COVID-19. It should be emphasized that comedication of JAK inhibitors and Tocilizumab is not recommended. Further high quality research is required for the widespread use of immunomodulating agents in COVID-19.
新冠病毒病（COVID-19）的病理生理过程可分为病毒复制期和炎症期。过度炎症反应会促使重症COVID-19的发展。因此，免疫调节剂受到关注。地塞米松已成为治疗重症COVID-19的标准治疗药物。两项大型随机试验以及一项对总计九项随机试验的荟萃分析表明，对于重症COVID-19患者，如果在标准治疗中添加托珠单抗（一种白细胞介素-6受体拮抗剂），死亡率会降低。使用巴瑞替尼（一种JAK 1/2抑制剂）进行治疗对未吸氧或低流量吸氧的患者可能也有益处。国内和国际指南推荐使用托珠单抗治疗重症COVID-19。对于中度COVID-19的住院患者，使用JAK抑制剂是一种治疗选择。应当强调的是，不推荐将JAK抑制剂与托珠单抗联合使用。免疫调节剂在COVID-19中的广泛应用还需要进一步的高质量研究。
