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Associations between immune-suppressive and stimulating drugs and novel COVID-19-a systematic review of current evidence.
Russell, Beth; Moss, Charlotte; George, Gincy; Santaolalla, Aida; Cope, Andrew; Papa, Sophie; Van Hemelrijck, Mieke.
  • Russell B; Translational Oncology and Urology Research, King's College London, London, UK.
  • Moss C; All authors contributed equally.
  • George G; Translational Oncology and Urology Research, King's College London, London, UK.
  • Santaolalla A; All authors contributed equally.
  • Cope A; Translational Oncology and Urology Research, King's College London, London, UK.
  • Papa S; All authors contributed equally.
  • Van Hemelrijck M; Translational Oncology and Urology Research, King's College London, London, UK.
Ecancermedicalscience ; 14: 1022, 2020.
Article in English | MEDLINE | ID: covidwho-44724
Semantic information from SemMedBD (by NLM)
1. Pharmaceutical Preparations TREATS Respiration Disorders
Subject
Pharmaceutical Preparations
Predicate
TREATS
Object
Respiration Disorders
2. Therapeutic immunosuppression TREATS Respiration Disorders
Subject
Therapeutic immunosuppression
Predicate
TREATS
Object
Respiration Disorders
3. Therapeutic immunosuppression TREATS Borg Category-Ratio 10 Perceived Exertion Score 5
Subject
Therapeutic immunosuppression
Predicate
TREATS
Object
Borg Category-Ratio 10 Perceived Exertion Score 5
4. Pharmaceutical Preparations TREATS Borg Category-Ratio 10 Perceived Exertion Score 5
Subject
Pharmaceutical Preparations
Predicate
TREATS
Object
Borg Category-Ratio 10 Perceived Exertion Score 5
5. American College of Cardiology/American Heart Association Lesion Complexity Score C PROCESS_OF Patients
Subject
American College of Cardiology/American Heart Association Lesion Complexity Score C
Predicate
PROCESS_OF
Object
Patients
6. COVID-19 PROCESS_OF Patients
Subject
COVID-19
Predicate
PROCESS_OF
Object
Patients
7. Pharmaceutical Preparations AFFECTS Immunity
Subject
Pharmaceutical Preparations
Predicate
AFFECTS
Object
Immunity
8. tacrolimus INHIBITS Interleukin-1
Subject
tacrolimus
Predicate
INHIBITS
Object
Interleukin-1
9. mycophenolate INHIBITS Interleukin-1
Subject
mycophenolate
Predicate
INHIBITS
Object
Interleukin-1
10. CTLA-4-Ig|CTLA4 INHIBITS Interleukin-1
Subject
CTLA-4-Ig|CTLA4
Predicate
INHIBITS
Object
Interleukin-1
11. Human B-Lymphocyte Antigen CD2 INHIBITS C0021755
Subject
Human B-Lymphocyte Antigen CD2
Predicate
INHIBITS
Object
C0021755
12. Anti-Inflammatory Agent TREATS C5203670
Subject
Anti-Inflammatory Agent
Predicate
TREATS
Object
C5203670
13. Anti-Inflammatory Agent TREATS C0030705
Subject
Anti-Inflammatory Agent
Predicate
TREATS
Object
C0030705
14. inhibitors AFFECTS COVID-19
Subject
inhibitors
Predicate
AFFECTS
Object
COVID-19
15. Coronavirus Infections PROCESS_OF Patients
Subject
Coronavirus Infections
Predicate
PROCESS_OF
Object
Patients
16. Genus: Coronavirus PROCESS_OF Patients
Subject
Genus: Coronavirus
Predicate
PROCESS_OF
Object
Patients
17. unwellness PROCESS_OF Patients
Subject
unwellness
Predicate
PROCESS_OF
Object
Patients
18. prednisolone AFFECTS COVID-19
Subject
prednisolone
Predicate
AFFECTS
Object
COVID-19
19. tacrolimus AFFECTS COVID-19
Subject
tacrolimus
Predicate
AFFECTS
Object
COVID-19
20. methotrexate TREATS Autoimmune Diseases
Subject
methotrexate
Predicate
TREATS
Object
Autoimmune Diseases
21. Pharmaceutical Preparations TREATS Respiration Disorders
Subject
Pharmaceutical Preparations
Predicate
TREATS
Object
Respiration Disorders
22. Therapeutic immunosuppression TREATS Respiration Disorders
Subject
Therapeutic immunosuppression
Predicate
TREATS
Object
Respiration Disorders
23. Therapeutic immunosuppression TREATS Borg Category-Ratio 10 Perceived Exertion Score 5
Subject
Therapeutic immunosuppression
Predicate
TREATS
Object
Borg Category-Ratio 10 Perceived Exertion Score 5
24. Pharmaceutical Preparations TREATS Borg Category-Ratio 10 Perceived Exertion Score 5
Subject
Pharmaceutical Preparations
Predicate
TREATS
Object
Borg Category-Ratio 10 Perceived Exertion Score 5
25. American College of Cardiology/American Heart Association Lesion Complexity Score C PROCESS_OF Patients
Subject
American College of Cardiology/American Heart Association Lesion Complexity Score C
Predicate
PROCESS_OF
Object
Patients
26. COVID-19 PROCESS_OF Patients
Subject
COVID-19
Predicate
PROCESS_OF
Object
Patients
27. Pharmaceutical Preparations AFFECTS Immunity
Subject
Pharmaceutical Preparations
Predicate
AFFECTS
Object
Immunity
28. tacrolimus INHIBITS Interleukin-1
Subject
tacrolimus
Predicate
INHIBITS
Object
Interleukin-1
29. mycophenolate INHIBITS Interleukin-1
Subject
mycophenolate
Predicate
INHIBITS
Object
Interleukin-1
30. CTLA-4-Ig|CTLA4 INHIBITS Interleukin-1
Subject
CTLA-4-Ig|CTLA4
Predicate
INHIBITS
Object
Interleukin-1
31. Human B-Lymphocyte Antigen CD20, human|MS4A1|KRT20 INHIBITS Interleukin-1
Subject
Human B-Lymphocyte Antigen CD20, human|MS4A1|KRT20
Predicate
INHIBITS
Object
Interleukin-1
32. Anti-Inflammatory Agents, Non-Steroidal TREATS COVID-19
Subject
Anti-Inflammatory Agents, Non-Steroidal
Predicate
TREATS
Object
COVID-19
33. Anti-Inflammatory Agents, Non-Steroidal TREATS Patients
Subject
Anti-Inflammatory Agents, Non-Steroidal
Predicate
TREATS
Object
Patients
34. inhibitors AFFECTS COVID-19
Subject
inhibitors
Predicate
AFFECTS
Object
COVID-19
35. Coronavirus Infections PROCESS_OF Patients
Subject
Coronavirus Infections
Predicate
PROCESS_OF
Object
Patients
36. Genus: Coronavirus PROCESS_OF Patients
Subject
Genus: Coronavirus
Predicate
PROCESS_OF
Object
Patients
37. unwellness PROCESS_OF Patients
Subject
unwellness
Predicate
PROCESS_OF
Object
Patients
38. prednisolone AFFECTS COVID-19
Subject
prednisolone
Predicate
AFFECTS
Object
COVID-19
39. tacrolimus AFFECTS COVID-19
Subject
tacrolimus
Predicate
AFFECTS
Object
COVID-19
40. methotrexate TREATS Autoimmune Diseases
Subject
methotrexate
Predicate
TREATS
Object
Autoimmune Diseases
ABSTRACT

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.
Keywords

Full text: Available Collection: International databases Database: MEDLINE Type of study: Evidence synthesis / Prognostic study / Reviews / Risk factors / Systematic review Language: English Journal: Ecancermedicalscience Year: 2020 Document Type: Article Affiliation country: Ecancer.2020.1022

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Full text: Available Collection: International databases Database: MEDLINE Type of study: Evidence synthesis / Prognostic study / Reviews / Risk factors / Systematic review Language: English Journal: Ecancermedicalscience Year: 2020 Document Type: Article Affiliation country: Ecancer.2020.1022