Kawazoe Mai, Kihara Mari, Nanki Toshihiro
Division of Rheumatology, Department of Internal Medicine, School of Medicine, Faculty of Medicine, Toho University, Tokyo 143-8541, Japan.
Department of Rheumatology, Tokyo Medical and Dental University, Tokyo 113-8519, Japan.
Pharmaceuticals (Basel). 2021 Dec 2;14(12):1256. doi: 10.3390/ph14121256.
Coronavirus disease 2019 (COVID-19) remains a global threat to humanity. Its pathogenesis and different phases of disease progression are being elucidated under the pandemic. Active viral replication activates various immune cells and produces large amounts of inflammatory cytokines, which leads to the cytokine storm, a major cause of patient death. Therefore, viral inhibition is expected to be the most effective early in the course of the disease, while immunosuppressive treatment may be useful in the later stages to prevent disease progression. Based on the pathophysiology of rheumatic diseases, various immunomodulatory and immunosuppressive drugs are used for the diseases. Due to their mechanism of action, the antirheumatic drugs, including hydroxychloroquine, chloroquine, colchicine, calcineurin inhibitors (e.g., cyclosporine A and tacrolimus), glucocorticoids, cytokines inhibitors, such as anti-tumor necrosis factor-α (e.g., infliximab), anti-interleukin (IL)-6 (e.g., tocilizumab, sarilumab, and siltuximab), anti-IL-1 (e.g., anakinra and canakinumab) and Janus kinase inhibitors (e.g., baricitinib and tofacitinib), cytotoxic T lymphocyte-associated antigen 4 blockade agents (e.g., abatacept), and phosphodiesterase 4 inhibitors (e.g., apremilast), have been tried as a treatment for COVID-19. In this review, we discuss the mechanisms of action and clinical impact of these agents in the management of COVID-19.
2019冠状病毒病（COVID-19）仍然是对人类的全球威胁。在这场大流行中，其发病机制和疾病进展的不同阶段正在被阐明。活跃的病毒复制激活各种免疫细胞并产生大量炎性细胞因子，这导致细胞因子风暴，而细胞因子风暴是患者死亡的主要原因。因此，预计在疾病过程早期抑制病毒最为有效，而免疫抑制治疗在后期可能有助于预防疾病进展。基于风湿性疾病的病理生理学，各种免疫调节和免疫抑制药物被用于这些疾病。由于其作用机制，抗风湿药物，包括羟氯喹、氯喹、秋水仙碱、钙调神经磷酸酶抑制剂（如环孢素A和他克莫司）、糖皮质激素、细胞因子抑制剂，如抗肿瘤坏死因子-α（如英夫利昔单抗）、抗白细胞介素（IL）-6（如托珠单抗、萨瑞鲁单抗和西妥昔单抗）、抗IL-1（如阿那白滞素和卡那单抗）和Janus激酶抑制剂（如巴瑞替尼和托法替布）、细胞毒性T淋巴细胞相关抗原4阻断剂（如阿巴西普）以及磷酸二酯酶4抑制剂（如阿普司特），已被尝试用于治疗COVID-19。在本综述中，我们讨论了这些药物在COVID-19治疗中的作用机制和临床影响。
