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Pharm Sci. 2021;27(Suppl 1): S13-S28.
doi: 10.34172/PS.2021.40
  Abstract View: 111
  PDF Download: 25

COVID-19

Review

Anti-Rheumatic Drugs as Potential Anti-inflammatory, Immunomodulatory Agents against COVID-19: A Systematic Review

Reza Sinaei 1,2 ORCID logo, Sara Pezeshki 2,3* ORCID logo, Ali Asadipour 4 ORCID logo, Reza Shiari 5 ORCID logo, Roya Sinaei 1 ORCID logo, Ali Sinaei 6 ORCID logo

1 Department of Pediatrics, School of Medicine, Kerman University of Medical Sciences, Kerman, Iran.
2 Endocrinology and Metabolism Research Center, Institute of Basic and Clinical Physiology Sciences, Kerman University of Medical Sciences, Kerman, Iran.
3 Department of Internal Medicine, Kerman University of Medical Sciences, Kerman, Iran.
4 Pharmaceutical Sciences and Cosmetic Products Research Center, Kerman University of Medical Sciences, Kerman, Iran.
5 Department of Pediatric Rheumatology, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
6 School of Pharmacy, Kerman University of Medical Sciences, Kerman, Iran.

Abstract

Background: The effective responses of both innate and adaptive immunity are crucial in combating novel coronavirus-2 infection. An excessive response may lead to cytokine storm, which is a challenging problem in therapeutic strategies.

Methods: A systematic review was carried out by searching Ovid MEDLINE, PubMed, Google Scholar, and Cochrane library databases from inception, for anti-inflammatory and immunomodulatory drugs against coronavirus disease 2019 (COVID-19).

Results: The results of the effectiveness of Hydroxychloroquine are just like a sinusoidal diagram and in a state of ambiguity. Thalidomide was effective in some cases but has not yet been proven. Low-dose Corticosteroids may be effective in the early stages of the illness as a bridge. There is no evidence of benefits or adverse outcomes for the use of non-steroidal anti-inflammatory drugs and Cyclosporine-A. In some critically ill patients, Interleukin-6 (IL-6) and IL-1 blockers and to some extent, Tumor-Necrosis-Factor-α and Janus-Kinase inhibitors are useful. Finally, high-dose intravenous immunoglobulin reversed the deterioration of patients in most trials.

Conclusion: One strategy behind the treatments for COVID-19 is based on breaking the cytokine storm. Although avoiding the suppression of anti-viral immunity is crucial by choosing the weaker and more selective anti-inflammatories, some strategies are kept for hyper-inflammatory situations. Scheduling of treatment is also important. Although low-dose steroids may be effective in the early stages of the illness, “Tocilizumab” is more effective in severe situations, when the IL-6 level is high and other drugs are ineffective. Therefore, consideration should be given to each patient separately.

Keywords: Anti-inflammatory, Immunomodulatory, COVID-19, SARS-CoV2
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Abstract View: 112

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Submitted: 10 Sep 2020
Revision: 14 Jul 2021
Accepted: 14 Jul 2021
ePublished: 15 Jul 2021
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