Published online Jul 9, 2022. doi: 10.5492/wjccm.v11.i4.269
Peer-review started: July 22, 2021
First decision: November 11, 2021
Revised: December 1, 2021
Accepted: May 16, 2022
Article in press: May 16, 2022
Published online: July 9, 2022
Processing time: 349 Days and 21.5 Hours
Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is the causative agent of the ongoing coronavirus disease 2019 (COVID-19) pandemic. Unders
To describe the interaction of SARS-CoV-2 with the immune system and the subsequent contribution of hyperinflammation and abnormal immune responses to disease progression together with a complete narrative review of the different immunoadjuvant treatments used so far in COVID-19 and their indication in severe and life-threatening subsets.
A comprehensive literature search was developed. Authors reviewed the selected manuscripts following the PRISMA recommendations for systematic review and meta-analysis documents and selected the most appropriate. Finally, a recommendation of the use of each treatment was established based on the level of evidence of the articles and documents reviewed. This recommendation was made based on the consensus of all the authors.
A brief rationale on the SARS-CoV-2 pathogenesis, immune response, and inflammation was developed. The usefulness of 10 different families of treatments related to inflammation and immunopathogenesis of COVID-19 was reviewed and discussed. Finally, based on the level of scientific evidence, a recommendation was established for each of them.
Although several promising therapies exist, only the use of corticosteroids and tocilizumab (or sarilumab in absence of this) have demonstrated evidence enough to recommend its use in critically ill patients with COVID-19. Endotypes including both, clinical and biological characteristics can constitute specific targets for better select certain therapies based on an individualized approach to treatment.
Core Tip: Two years after the onset of the pandemic the search for the most appropriate treatment of coronavirus disease 2019 (COVID-19) continues. Few treatments have been evaluated in the context of critically ill patients with COVID-19 considering it in most clinical trials as a negative “end point” of the disease rather than a study subject. This fact makes it extremely difficult to establish degrees of recommendation regarding the different therapeutic options currently available. This review aims to summarize the immunopathogenesis and the current evidence regarding the different immunomodulatory strategies tested in critically ill patients with COVID-19. In addition, the presence of different immunophenotypes that in the future will serve as a basis for individualized treatments is demonstrated.