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    Thais Romano
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    Multiple immune-modulating drugs have shown potential benefit for treating infections like COVID-19. Glucocorticoids like dexamethasone reduce mortality in patients with hypoxemia. Janus kinase inhibitors like baricitinib improve recovery time, especially in patients requiring oxygen supplementation. While interleukin-6 inhibitors showed early promise, randomized controlled trials found limited or no benefit. Interferons may enhance antiviral response, but large trials found no clear benefit for COVID-19 patients. Guidelines recommend dexamethasone, baricitinib, and conditional use of interleukin-6 inhibitors for severe disease.

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    Multiple immune-modulating drugs have shown potential benefit for treating infections like COVID-19. Glucocorticoids like dexamethasone reduce mortality in patients with hypoxemia. Janus kinase inhibitors like baricitinib improve recovery time, especially in patients requiring oxygen supplementation. While interleukin-6 inhibitors showed early promise, randomized controlled trials found limited or no benefit. Interferons may enhance antiviral response, but large trials found no clear benefit for COVID-19 patients. Guidelines recommend dexamethasone, baricitinib, and conditional use of interleukin-6 inhibitors for severe disease.

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    3 views1 page

    Immunomodulators Infographic

    Uploaded by

    Thais Romano
    Multiple immune-modulating drugs have shown potential benefit for treating infections like COVID-19. Glucocorticoids like dexamethasone reduce mortality in patients with hypoxemia. Janus kinase inhibitors like baricitinib improve recovery time, especially in patients requiring oxygen supplementation. While interleukin-6 inhibitors showed early promise, randomized controlled trials found limited or no benefit. Interferons may enhance antiviral response, but large trials found no clear benefit for COVID-19 patients. Guidelines recommend dexamethasone, baricitinib, and conditional use of interleukin-6 inhibitors for severe disease.

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    IMMUNE MODULATION GLUCOCORTICOIDS

    • Dexamethasone, methylprednisolone,
    JANUS KINASE (JAK) INHIBITORS
    • Baricitinib, ruxolitinib
    FOR INFECTIONS hydrocortisone
    • Reduced mortality in landmark RECOVERY
    •
    •
    Broad-spectrum anti-inflammatory drugs
    Potential antiviral effects
    INCLUDING COVID-19 trial in patients with COVID-191
    • Mortality decrease in patients with • Benefit seen in ACTT-2: Improved time to
    recovery, especially in patients on NIV or
    hypoxemia
    HHFNC
    COVID-19 provokes a dysregulated inflammatory • Signal for harm in patients without
    hypoxemia • Limited benefit in patients on mechanical
    response in patients with critical illness. ventilation
    • Advocated by NIH, IDSA, & SSC guidelines
    • Standard dose is • NIH and IDSA recommend baricitinib plus
    Multiple immune-modulating drugs have been remdesivir only for nonintubated patients
    • Dexamethasone 6 mg IV or PO daily
    studied for the treatment of patients with severe for up to 10 days who require oxygen supplementation and
    for whom dexamethasone is contraindicated
    hypoxemia. • Not recommended for outpatients

    IL-6 INHIBITORS INTERFERONS


    • Tocilizumab, sarilumab • Enhanced host immune response to viral
    • Early interest due to anecdotal reports of infections
    similarities between COVID-19 critical • Early evidence of benefit in trial in Hong
    illness and cytokine storm seen in CAR-T Kong2
    cell therapy • Improved clinical outcomes with inhaled
    t • Industry-sponsored trials stopped due to
    lack of benefit
    t
    IFN-beta in a UK RCT3 and enhanced
    virologic clearance seen in outpatients
    • Multiple conflicting RCTs, although interest with IFN-lambda4
    recently renewed by evidence of decreased • No benefit seen to SC or IV IFN-beta in
    ICU mortality by the REMAP-CAP and the open-label WHO Solidarity trial5
    RECOVERY groups • Not currently recommended by NIH, IDSA,
    • Conditional recommendation by IDSA for or SSC guideline panels
    use in severe and critical disease

    1The RECOVERY Collaborative Group. N Engl J Med. 2020.


    2Hung, et al. Lancet. 2020.
    3Monk, et al. Lancet Respir Med. 2020.
    4 Feld, et al. Lancet Respir Med. 2021.
    5WHO Solidarity Trial Consortium. N Engl J Med. 2020.

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