Abstract
In December 2019, following a cluster of pneumonia cases in China caused by a novel coronavirus (CoV), named severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), the infection disseminated worldwide and, on March 11th, 2020, the World Health Organization officially declared the pandemic of the relevant disease named coronavirus disease 2019 (COVID-19). In Europe, Italy was the first country facing a true health policy emergency, and, as at 6.00 p.m. on May 2nd, 2020, there have been more than 209,300 confirmed cases of COVID-19. Due to the increasing number of patients experiencing a severe outcome, global scientific efforts are ongoing to find the most appropriate treatment. The usefulness of specific anti-rheumatic drugs came out as a promising treatment option together with antiviral drugs, anticoagulants, and symptomatic and respiratory support. For this reason, we feel a duty to share our experience and our knowledge on the use of these drugs in the immune-rheumatologic field, providing in this review the rationale for their use in the COVID-19 pandemic.
Highlights
In December 2019, an outbreak of an unknown infectious disease denominated coronavirus (CoV) disease 2019 (COVID-19), caused by a novel CoV named severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) [1], was reported in Wuhan, the capital of Hubei Province, People’s Republic of China [2]
Results from more than 100 patients with COVID-19 demonstrated that CQ is superior to the control treatment in inhibiting the exacerbation of pneumonia, improving lung imaging findings, promoting a virus-negative conversion, and shortening the disease course in the absence of severe adverse reactions [104], no data about clinical characteristics and demographics of both groups were reported
A study from China seems to demonstrate a reduction in time to clinical response as well as a better progression of pneumonia in patients treated with HCQ in association with the standard of care compared to those not treated with HCQ [107], while another small Chinese pilot study showed no difference between HCQ-treated patients and a control group in terms of the negative conversion rate of pharyngeal swabs, duration of fever, and radiographic progression on CT chest images [108]
Summary
In December 2019, an outbreak of an unknown infectious disease denominated coronavirus (CoV) disease 2019 (COVID-19), caused by a novel CoV named severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) [1], was reported in Wuhan, the capital of Hubei Province, People’s Republic of China [2]. The increased vascular coagulation occurring in COVID-19 patients is more similar to a lung-centric intravascular coagulopathy (PIC) than it is to the classical DIC [17] This peculiar presentation seems related to a macrophage activation syndrome (MAS)-like intrapulmonary inflammation, which differs from the classical MAS observed along the course of inflammatory or infectious conditions [17]. It is likely that, in severe cases of COVID-19, the development of DIC derives from multiple factors orchestrated by pro-inflammatory molecules, including IL-6, that concur in damaging blood vessels, interfering with coagulation, and inducing endothelial cell activation In line with this evidence, IL6 inhibition may be beneficial for cardiovascular thrombotic complications occurring in patients with COVID-19. The antiviral activity of antimalarials is further enhanced, at least in vitro, by the capacity to alter protein glycosylation including that of the viral envelop proteins, interfering with the virus assembly and release of mature virus particles [90]
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