Background 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. Methods Using 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. Results 89 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. Conclusion The 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.
【저자키워드】 COVID-19, Cancer, immune modulation, adverse events, Immune suppression, 【초록키워드】 Treatment, Necrosis, coronavirus, Cytokines, IL-6, COVID-19 pandemic, severity, drugs, drug, inhibitors, Steroids, respiratory diseases, Chemotherapy, NSAIDS, low-dose, Impact, Patient, target, methotrexate, inhibitor, Jak, patients, IL-1, anti-CD20, IL-6 inhibitor, JAK-STAT pathway, Kinase inhibitor, Evidence, Janus kinase, COVID-19 patient, Cytotoxic chemotherapy, Prednisolone, In vitro studies, acute respiratory syndrome, non-steroidal anti-inflammatory drug, higher risk, modulation, host immunity, secretion, pulmonary complications, TNFα, pro-inflammatory cytokine, blockade, OVID, blockers, Effect, auto-immune disease, Result, shown, elevated, treated, coronavirus, less, induce, patients with COVID-19, 【제목키워드】 systematic review, drug, Evidence,