Division of Rheumatology, Department of Internal Medicine, Gazi University, Ankara, Turkey
Division of Rheumatology AOUC, Department of Experimental and Clinical Medicine, University of Florence , Florence, Italy
Turk J Med Sci. 2021 Dec 17;51(SI-1):3391-3404. doi: 10.3906/sag-2110-179.
In the Wuhan province of China, almost two years ago, in December 2019, the novel Coronavirus 2019 has caused a severe involvement of the lower respiratory tract leading to an acute life-threatening respiratory syndrome, coronavirus disease-19 (COVID-19). Subsequently, coronavirus 2 (SARS-CoV-2) rapidly spread to the entire world causing a pandemic and affected every single person on earth either directly or indirectly with destroying all facets of social life and economy. Since the announcement of COVID-19 as a global pandemic, we have witnessed tremendous scientific work on all aspects of COVID-19 across the globe, which has never been witnessed before. The most remarkable achievement would be the introduction of vaccines, which provide protection from the severe infection and is the only premise for the control of disease. However, despite the tremendous work, the number of treatments either antiviral or immunomodulatory for infected patients are considerably limited, yet disease is causing substantial morbidity and mortality. COVID-19 follows heterogenous disease course among infected individuals, and dysregulated immune system is primarily responsible for the worse outcomes. Immune deficiency, being on corticosteroids for inflammatory diseases, delayed interferon response and advanced age adversely influence prognosis with impairing viral clearance. On the other hand, exuberant immune response with features of cytokine storm is the leading cause of death, which can be alleviated by use of either general immunosuppression with corticosteroids or selective neutralization of potent pro-inflammatory cytokines such as interleukin (IL)-1 and IL-6. Herein, we summarized the potential effective immunomodulatory treatments emphasizing in which patient population it is the most suitable, which dose should be administered, and which is the most appropriate timepoint to administer the drug during the course of the disease.
在中国湖北省，大约两年前，也就是 2019 年 12 月，新型冠状病毒 2019 引起了严重的下呼吸道受累，导致急性危及生命的呼吸综合征，即冠状病毒病 19（COVID-19）。随后，冠状病毒 2（SARS-CoV-2）迅速传播到全球，引发了大流行，直接或间接地影响了地球上的每一个人，摧毁了社会生活和经济的方方面面。自 COVID-19 被宣布为全球大流行以来，我们见证了全球范围内对 COVID-19 各个方面的巨大科学工作，这是前所未有的。最显著的成就是引入了疫苗，疫苗为严重感染提供了保护，是控制疾病的唯一前提。然而，尽管做了巨大的工作，针对感染患者的治疗方法（抗病毒或免疫调节）仍然相当有限，但疾病仍在导致大量发病率和死亡率。COVID-19 在感染个体中呈现出异质的疾病过程，而失调的免疫系统是导致不良结局的主要原因。免疫缺陷、因炎症性疾病而接受皮质类固醇治疗、干扰素反应延迟和年龄增长都对预后产生不利影响，从而影响病毒清除。另一方面，细胞因子风暴等特征的过度免疫反应是导致死亡的主要原因，使用皮质类固醇等一般性免疫抑制或选择性中和强效促炎细胞因子（如白细胞介素[IL]-1 和 IL-6）可以缓解这种情况。在此，我们总结了潜在的有效免疫调节治疗方法，重点强调了哪些患者群体最适合使用，应该给予哪种剂量，以及在疾病过程中给予药物的最合适时间点。
