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Associations between immune-suppressive and stimulating drugs and novel COVID-19 - A systematic review of current evidence

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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.

In: ecancermedicalscience, Vol. 14, e1022, 27.03.2020.

Research output: Contribution to journalReview article

Harvard

Russell, B, Moss, C, George, G, Santaolalla, A, Cope, A, Papa, S & Van Hemelrijck, M 2020, 'Associations between immune-suppressive and stimulating drugs and novel COVID-19 - A systematic review of current evidence', ecancermedicalscience, vol. 14, e1022. https://doi.org/10.3332/ecancer.2020.1022

APA

Russell, B., Moss, C., George, G., Santaolalla, A., Cope, A., Papa, S., & Van Hemelrijck, M. (2020). Associations between immune-suppressive and stimulating drugs and novel COVID-19 - A systematic review of current evidence. ecancermedicalscience, 14, [e1022]. https://doi.org/10.3332/ecancer.2020.1022

Vancouver

Russell B, Moss C, George G, Santaolalla A, Cope A, Papa S et al. Associations between immune-suppressive and stimulating drugs and novel COVID-19 - A systematic review of current evidence. ecancermedicalscience. 2020 Mar 27;14. e1022. https://doi.org/10.3332/ecancer.2020.1022

Author

Russell, Beth ; Moss, Charlotte ; George, Gincy ; Santaolalla, Aida ; Cope, Andrew ; Papa, Sophie ; Van Hemelrijck, Mieke. / Associations between immune-suppressive and stimulating drugs and novel COVID-19 - A systematic review of current evidence. In: ecancermedicalscience. 2020 ; Vol. 14.

Bibtex Download

@article{01dd62804eb348b1bdf2319760040bd2,
title = "Associations between immune-suppressive and stimulating drugs and novel COVID-19 - A systematic review of current evidence",
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 proinflammatory 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 = "Adverse events, Cancer, COVID-19, Immune modulation, Immune suppression",
author = "Beth Russell and Charlotte Moss and Gincy George and Aida Santaolalla and Andrew Cope and Sophie Papa and {Van Hemelrijck}, Mieke",
year = "2020",
month = "3",
day = "27",
doi = "10.3332/ecancer.2020.1022",
language = "English",
volume = "14",
journal = "ecancermedicalscience",
issn = "1754-6605",
publisher = "Cancer Intellilgence",

}

RIS (suitable for import to EndNote) Download

TY - JOUR

T1 - Associations between immune-suppressive and stimulating drugs and novel COVID-19 - A systematic review of current evidence

AU - Russell, Beth

AU - Moss, Charlotte

AU - George, Gincy

AU - Santaolalla, Aida

AU - Cope, Andrew

AU - Papa, Sophie

AU - Van Hemelrijck, Mieke

PY - 2020/3/27

Y1 - 2020/3/27

N2 - 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 proinflammatory 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.

AB - 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 proinflammatory 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.

KW - Adverse events

KW - Cancer

KW - COVID-19

KW - Immune modulation

KW - Immune suppression

UR - http://www.scopus.com/inward/record.url?scp=85083636640&partnerID=8YFLogxK

U2 - 10.3332/ecancer.2020.1022

DO - 10.3332/ecancer.2020.1022

M3 - Review article

AN - SCOPUS:85083636640

VL - 14

JO - ecancermedicalscience

JF - ecancermedicalscience

SN - 1754-6605

M1 - e1022

ER -

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