Abstract
BackgroundCancer 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.MethodsUsing 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.Results89 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 pro-inflammatory 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.ConclusionThe COVID-19 pandemic has led to challenging decision-making about treatment of critically unwell patients. Low-dose prednisolone and tacrolimus may have beneficial impacts 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.
Highlights
Since the outbreak of severe acute respiratory syndrome (SARS)-CoV-2 or COVID-19 coronavirus started in China in December 2019, there is increasing evidence that those with existing comorbidities, older age or a compromised immune system are at higher risk of developing severe and even fatal respiratory diseases [1]
We hypothesise that the drugs selected will likely be categorised into one of two groups: 1) those that may be harmful for patients and put them at risk of increased morbidity/mortality associated with COVID-19 infection and 2) those that may be used to treat the immunopathology associated with severe persistent viral infection
This review demonstrated that it is evident that IL-1 is elevated in patients infected with a coronavirus, there is not at present evidence for an established role for IL-1 blockers in the treatment of COVID-19 in humans
Summary
Since the outbreak of severe acute respiratory syndrome (SARS)-CoV-2 or COVID-19 coronavirus started in China in December 2019, there is increasing evidence that those with existing comorbidities, older age or a compromised immune system are at higher risk of developing severe and even fatal respiratory diseases [1]. Cancer and transplant patients are considered to be in this risk group [2, 3], especially as they may be treated with immune-suppressive or immune-stimulating drugs. The current review focuses on the effects of immune-suppressive or immune-stimulating drugs on the host immunity against COVID-19. The clinical impact of this review is, twofold It aims to identify which drugs clinicians should be thinking about taking patients off to protect them from increased harm from COVID-19 and which drugs could be potentially beneficial in the fight against the disease. 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
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