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A guide to immunotherapy for COVID-19

Research output: Contribution to journalArticlepeer-review

Frank L. van de Veerdonk, Evangelos Giamarellos-Bourboulis, Peter Pickkers, Lennie Derde, Helen Leavis, Reinout van Crevel, Job J. Engel, W. Joost Wiersinga, Alexander P.J. Vlaar, Manu Shankar-Hari, Tom van der Poll, Marc Bonten, Derek C. Angus, Jos W.M. van der Meer, Mihai G. Netea

Original languageEnglish
Pages (from-to)39-50
Number of pages12
JournalNature Medicine
Issue number1
Early online date21 Jan 2022
Accepted/In press2022
E-pub ahead of print21 Jan 2022
PublishedJan 2022

Bibliographical note

Funding Information: F.L.v.d.V. gratefully acknowledges financial support from the Netherlands Organization for Scientific Research (Vidi grant from ZonMW & ZonMW project nr 10430012010010).M.G.N. was supported by a Spinoza grant of the Netherlands Association for Scientific Research. Publisher Copyright: © 2022, Springer Nature America, Inc.

King's Authors


Immune dysregulation is an important component of the pathophysiology of COVID-19. A large body of literature has reported the effect of immune-based therapies in patients with COVID-19, with some remarkable successes such as the use of steroids or anti-cytokine therapies. However, challenges in clinical decision-making arise from the complexity of the disease phenotypes and patient heterogeneity, as well as the variable quality of evidence from immunotherapy studies. This Review aims to support clinical decision-making by providing an overview of the evidence generated by major clinical trials of host-directed therapy. We discuss patient stratification and propose an algorithm to guide the use of immunotherapy strategies in the clinic. This will not only help guide treatment decisions, but may also help to design future trials that investigate immunotherapy in other severe infections.

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