2021 update of the EULAR points to consider on the use of immunomodulatory therapies in COVID-19
2021 update of the EULAR points to consider on the use of immunomodulatory therapies in COVID-19
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DOI：
10.1136/annrheumdis-2021-221366
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发表时间：
2021-10-07
影响因子：
27.4
通讯作者：
Mariette, Xavier
中科院分区：
文献类型：
--
作者：
Alunno, Alessia;Najm, Aurelie;Mariette, Xavier
目的更新EULAR关于在COVID-19中使用免疫调节疗法的考虑要点（PtCs）。方法根据EULAR标准化操作程序，进行了截至2021年7月14日的系统性文献综述，并随后召开了国际多学科工作组的共识会议。新的发言经正式表决合并。结果我们更新了2个总体原则和12个PtC。证据仅在中度至重度和危重患者中可用。糖皮质激素单用或与托珠单抗联合使用对需要氧疗的COVID-19病例和危重COVID-19患者有益。Janus激酶抑制剂（baricitinib和tofacitinib）的使用在重度和危重COVID-19的相同人群中是有希望的。抗SARS-CoV-2单克隆抗体和恢复期血浆可用于疾病的早期阶段和免疫抑制患者的选定亚组。其他免疫调节剂的疗效没有足够的有力证据，需要进一步研究IL-1治疗的生物标志物分层。结论越来越多的证据支持糖皮质激素单独或与托珠单抗/Janus激酶抑制剂联合治疗中重度和危重COVID-19的疗效增加。正在进行的研究可能揭示其他治疗方法的潜在应用。应鼓励风湿病学家作为系统性炎症疾病专家参与COVID-19免疫调节治疗的临床试验。
Objectives To update the EULAR points to consider (PtCs) on the use of immunomodulatory therapies in COVID-19. Methods According to the EULAR standardised operating procedures, a systematic literature review up to 14 July 2021 was conducted and followed by a consensus meeting of an international multidisciplinary task force. The new statements were consolidated by formal voting. Results We updated 2 overarching principles and 12 PtC. Evidence was only available in moderate to severe and critical patients. Glucocorticoids alone or in combination with tocilizumab are beneficial in COVID-19 cases requiring oxygen therapy and in critical COVID-19. Use of Janus kinase inhibitors (baricitinib and tofacitinib) is promising in the same populations of severe and critical COVID-19. Anti-SARS-CoV-2 monoclonal antibodies and convalescent plasma may find application in early phases of the disease and in selected subgroups of immunosuppressed patients. There was insufficient robust evidence for the efficacy of other immunomodulators with further work being needed in relation to biomarker-based stratification for IL-1 therapy Conclusions Growing evidence supports incremental efficacy of glucocorticoids alone or combined with tocilizumab/Janus kinase inhibitors in moderate to severe and critical COVID-19. Ongoing studies may unmask the potential application of other therapeutic approaches. Involvement of rheumatologists, as systemic inflammatory diseases experts, should be encouraged in clinical trials of immunomodulatory therapy in COVID-19.