ecancermedicalscience

Review

Associations between immune-suppressive and stimulating drugs and novel COVID-19—a systematic review of current evidence

27 Mar 2020
Beth Russell, Charlotte Moss, Gincy George, Aida Santaolalla, Andrew Cope, Sophie Papa, Mieke Van Hemelrijck

Background: Cancer and transplant patients with Covid-19 have a higher risk of developing severe and even fatal respiratory diseases, especially as they may be treated with immune-suppressive or immune-stimulating drugs. This review focuses on the effects of these drugs on host immunity against COVID-19.

Methods: Using Ovid MEDLINE, we reviewed current evidence for immune suppressing or stimulating drugs: cytotoxic chemotherapy, low dose steroids, tumour necrosis factorα (TNFα) blockers, interlukin-6 (IL-6) blockade, Janus kinase (JAK) inhibitors, IL-1 blockade, mycophenolate, tacrolimus, anti-CD20 and CTLA4-Ig.

Results: 89 studies were included. Cytotoxic chemotherapy has been shown to be a specific inhibitor for severe acute respiratory syndrome coronavirus in in vitro studies, but no specific studies exist as of yet for COVID-19. No conclusive evidence for or against the use of non-steroidal anti-inflammatory drugs (NSAIDs) in the treatment of COVID-19 patients is available, nor is there evidence indicating that TNFα blockade is harmful to patients in the context of COVID-19. COVID-19 has been observed to induce a proinflammatory cytokine generation and secretion of cytokines, such as IL-6, but there is no evidence of the beneficial impact of IL-6 inhibitors on the modulation of COVID-19. Although there are potential targets in the JAK-STAT pathway that can be manipulated in treatment for coronaviruses and it is evident that IL-1 is elevated in patients with a coronavirus, there is currently no evidence for a role of these drugs in treatment of COVID-19.

Conclusion: The COVID-19 pandemic has led to challenging decision making about treatment of critically unwell patients. Low dose prednisolone and tacrolimus may have beneficial impact on COVID-19. The mycophenolate mofetil picture is less clear, with conflicting data from pre-clinical studies. There is no definitive evidence that specific cytotoxic drugs, low dose methotrexate for auto-immune disease, NSAIDs, JAK kinase inhibitors or anti-TNFα agents are contraindicated. There is clear evidence that IL-6 peak levels are associated with severity of pulmonary complications.

Related Articles

Akhil Kapoor, Anuj Gupta, Bipinesh Sansar, Pooja Gupta, Bal Krishna Mishra, Arpita Singh, Arvind Upadhyay, Amit Kumar, Mayank Tripathi, Zachariah Chowdhury, Shashikant Patne, Ipsita Dhal, Neha Singh, Shreya Shukla, Satyendra Narayan Singh, Lincoln Pujari, Prashanth Giridhar, Ankita Rungta Kapoor, Yash Jain, Manikandan Venkatachalam, Somnath Dey, Kunal Ranjan Vinayak
Ankita Chitre, Akhil Kapoor, Bipinesh Sansar, Anuj Gupta, Praveen Lakshmanamurthy, Somnath Dey, Kunal Vinayak, Ajit Sahoo, Navneet Kaur, Sumaiya Azeem, Dipti Kadu, Akash Anand Shrivastav
Natalia Camejo, Camila Montenegro, Dahiana Amarillo, Cecilia Castillo, Gabriel Krygier
Misbah Younus Soomro, Saqib Raza Khan, Hashim Ishfaq, Insia Ali, Mirza Rameez Samar, Arif Hameed, Nawazish Zehra, Munira Moosajee, Yasmin Abdul Rashid