2021 update of the EULAR points to consider on the use of immunomodulatory therapies in COVID-19 (Part 4)

We now continue our discussion  of the overarching principles and points to consider in the use of immunomodulatory treatment in Coronavirus disease (Covid), with levels of evidence (LoE) and levels of agreement (LoA), which we started last week.

We start this week by mentioning the European Alliance of Association of Rheumatology’s (EULAR) guidelines on the use immunomodulatory therapies fornCovid patients.
In patients without hypogammaglobulinaemia and with symptom onset less than 5 days, there is solid evidence against the use of convalescent plasma.
Moreover, in patients at risk of severe Covid with symptom onset less than 5 days or still seronegative, it is best to consider monoclonal antibodies.
There is no sufficient evidence to use other immunomodulatory drugs such as interferon alpha, interferon beta, interferon kappa, interferon lambda, leflunomide, eculizumab and cyclosporine.
We now move the points to consider (PTC) on the use of immunomodulatory treatment in Covid infection.
The phenotype of SARS- CoV- 2 virus infection is heterogeneous ranging from asymptomatic to potentially lethal disease . This is  due to multiorgan damage.
SARS- CoV- 2 infection needs different treatment tactics, including antiviral, oxygen therapy, anticoagulation and/or immunomodulatory treatment at different stages of the disease. .
Covid infection may need different treatment approaches, including antiviral, oxygen therapy, anticoagulation and/or immunomodulatory treatment at different stages of the disease.
It is not good to use immunomodulatory therapy for non-hospitalized Covid patients. For hospitalized patients with Covid who do not need oxygen therapy, there is currently no evidence to support the use of immunomodulatory as a treatment.
Experts say that the use of hydrochloroquine needs to be avoided as treatment at any stage of Covid infection. Hydrochloroquine does not provide additional benefit to standard care and may even lead to a bad prognosis especially among patients who are taking azithromycin.
Systemic glucosteroids can help decrease mortality especially among patients who need supplemental oxygen, non- invasive or mechanical ventilation.
The combination of glucocorticoids and tocilizumab is recommended for Covid patients needing oxygen therapy andnon- invasive or mechanical ventilation. This combination can help in slowing down disease progression and mortality.
There are more points to consider presented by experts at EULAR and we will discuss them in our succeeding columns.