2021 update of the EULAR points to consider in the use of immunomodulatory therapies in COVID-19 (Part 4)
Let us now move to the fourth and final installment of our discussion which we started several weeks ago.
Before anything else, I would like to provide a refresher about the infection known as Coronavirus disease (Covid), which is caused by the SARS-CoV-2 virus.
The Coronavirus disease (Covid) infected patient may show no symptoms or the illness could be fatal due to multiorgan damage.
SARS- CoV- 2 infection may need different treatment approaches, including antiviral, oxygen therapy, anticoagulation and/or immunomodulatory treatment at different stages of the disease.
At this point, we now continue some of the points to consider in the treatment of Covid using immunomodulatory therapies.
Based on studies, there is no solid evidence to back the use of anakinra at any stage of the Covid.
Moreover, there is no solid evidence to use anakinra or canakinumab at any point of the disease.
The Covid patients requiring non- invasive ventilation or high- flow oxygen, the combination of remdesivir plus baricitinib is something that should be looked at by the medical professional as a possible treatment modality.
The said combination has been proven to decrease the time of isolation or confinement as it accelerates the improvement in the clinical status.
The evidence is currently not sufficient to recommend the use of drugs such as ruxolitinib, intravenous immunoglobin, convalescent plasma therapy (except in immunoglobulin- deficient patients) interferon kappa, interferon beta, leflunomide, colchicine sarilumab, lenzilumab, eculizumab, cyclosporine, interferon alpha and canakinumab. There is a need for more studies in order to provide more proof whether or not they are drugs that can be used by a doctor on a Covid patient.
Applying low- dose colchicine is something that should not be done at any stage of the disease as there is no solid evidence to support that the drug is effective.
Experts are not yet keen on recommending mavrilimumab, otilimab, and lenzilumab as treatment at any stage of Covid.
In Covid patients who are without hypogammaglobulinaemia and with symptom onset less than 5 days, there is solid evidence not to use of convalescent plasma.
The patients who are at risk of severe Covid, with symptom onset less than 5 days, or still seronegative, it is best to consider the use of monoclonal antibodies.
As we conclude this discussion, we need to understand that the treatment recommendations are constantly evolving based on the randomized control trials being performed by the experts.
It is possible that the points to consider and the recommendations of the European Alliance of Associations for Rheumatology (EULAR) may change based on new pieces of evidence that emerge later.
While we are constantly looking for therapies and treatment for Covid, the best way is to avoid getting infected in the first place or to get vaccinated.
The minimum health and safety protocol remain as the first line of defense against Covid while vaccinations can help reduce the risk of the patient getting hospitalized or worse dying due to the disease.
As they say prevention, is better than cure.