Abstract
In severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection, viral load peaks early and declines quickly after symptom onset. Severe coronavirus disease 2019 (COVID-19) is marked by aberrant innate and adaptive immune responses with an abnormal cytokine profile and multiorgan system dysfunction that persists well after viral clearance. A purely antiviral treatment strategy may therefore be insufficient, and antiviral agents have not shown a benefit later in the illness course. A number of immunomodulatory strategies are being tested, including corticosteroids, cytokine and anticytokine therapies, small molecule inhibitors, and cellular therapeutics. To date, the only drug to show a mortality benefit for COVID-19 in a randomized, controlled trial is dexamethasone. However, there remains uncertainty about which patients may benefit most and about longer-term complications, including secondary infections. Here, we review the immune dysregulation of severe COVID-19 and the existing data behind various immunomodulatory strategies, and we consider future directions of study.
Original language | English (US) |
---|---|
Pages (from-to) | E1130-E1143 |
Journal | Clinical Infectious Diseases |
Volume | 72 |
Issue number | 12 |
DOIs | |
State | Published - Jun 15 2021 |
Keywords
- COVID-19
- SARS-CoV-2
- cytokine storm
- hyperinflammatory
- immunomodulation
ASJC Scopus subject areas
- Microbiology (medical)
- Infectious Diseases