Chinta Siddharth, Rodriguez-Guerra Miguel, Shaban Mohammed, Pandey Neelanjana, Jaquez-Duran Maria, Vittorio Timothy J
Department of Medicine, BronxCare Hospital Center, Icahn School of Medicine at Mt. Sinai, Bronx, NY, USA.
Department of Medicine, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA.
Drugs Context. 2023 Feb 7;12. doi: 10.7573/dic.2022-7-2. eCollection 2023.
The SARS-CoV-2 pandemic is the most globally impacting health issue our world has faced over the last century. As of January 7, 2022, around 300 million cases have been reported worldwide, with over 5 million deaths. The SARS-CoV-2 infection causes a hyperactive host immune response leading to an excessive inflammatory reaction with the release of many cytokines - cytokine storm - commonly noticed in acute respiratory distress syndrome, sepsis and fulminant multiorgan failure. Since the beginning of the pandemic, the scientific medical community has worked on therapeutic procedures that interfere with the exaggerated immune response. Thromboembolic complications are widespread in patients who are critically ill with COVID-19. Anticoagulant therapy was initially considered a cornerstone in hospitalized patients and even in the early post-discharge period; however, later trials have aborted the clinical benefits except for suspicion of or confirmed thrombosis. Immunomodulatory therapies are still crucial in moderate to severe COVID-19. Immunomodulator therapies include various medications from steroids to hydroxychloroquine, tocilizumab and Anakinra. Anti-inflammatory agents, vitamin supplements and antimicrobial therapy had initial encouraging evidence, but there are limited data to review. Convalescent plasma, immunoglobulins, eculizumab, neutralizing IgG1 monoclonal antibodies and remdesivir have positively impacted inpatient mortality and hospital length of stay. Eventually, wide population vaccination was proven to be the best tool to overcome the SARS-CoV-2 pandemic and help humanity return to regular life. Many vaccines and various strategies have been used since December 2020. This review discusses how the SARS-CoV-2 pandemic has progressed and surged, and summarizes the safety and efficacy of the most used therapies and vaccines in the light of recent evidence.
2019冠状病毒病大流行是过去一个世纪以来全球面临的最具影响力的健康问题。截至2022年1月7日，全球报告的病例约达3亿例，死亡人数超过500万。2019冠状病毒病感染会引发宿主免疫反应亢进，导致过度炎症反应，并释放许多细胞因子——细胞因子风暴，这在急性呼吸窘迫综合征、脓毒症和暴发性多器官功能衰竭中很常见。自大流行开始以来，科学医学界一直在研究干扰过度免疫反应的治疗方法。血栓栓塞并发症在重症2019冠状病毒病患者中很常见。抗凝治疗最初被认为是住院患者甚至出院后早期的基石；然而，后来的试验未发现临床益处，除非怀疑或确诊血栓形成。免疫调节疗法在中度至重度2019冠状病毒病中仍然至关重要。免疫调节疗法包括从类固醇到羟氯喹、托珠单抗和阿那白滞素等各种药物。抗炎药、维生素补充剂和抗菌治疗最初有令人鼓舞的证据，但可供审查的数据有限。康复期血浆、免疫球蛋白、依库珠单抗、中和性IgG1单克隆抗体和瑞德西韦对住院患者死亡率和住院时间产生了积极影响。最终，广泛的人群疫苗接种被证明是战胜2019冠状病毒病大流行并帮助人类恢复正常生活的最佳工具。自2020年12月以来，人们使用了许多疫苗和各种策略。本综述讨论了2019冠状病毒病大流行是如何发展和激增的，并根据最新证据总结了最常用治疗方法和疫苗的安全性和有效性。
