Antirheumatic Drugs against COVID-19 from the Perspective of Rheumatologists

Area of Science:

• Immunology
• Pharmacology
• Infectious Diseases

Background:

• Coronavirus disease 2019 (COVID-19) poses a significant global health threat.
• Understanding COVID-19 pathogenesis reveals distinct phases, with viral replication triggering cytokine storms and immunosuppression potentially aiding later stages.
• Rheumatic diseases share pathophysiological similarities with COVID-19, suggesting therapeutic overlap.

Purpose of the Study:

• To review the mechanisms of action of various antirheumatic drugs investigated for COVID-19 treatment.
• To evaluate the clinical impact of these immunomodulatory and immunosuppressive agents in managing COVID-19.

Main Methods:

• Literature review of antirheumatic drugs with immunomodulatory or immunosuppressive properties.
• Analysis of drug mechanisms relevant to COVID-19 pathogenesis (viral replication and cytokine storm).
• Examination of clinical data and studies on the efficacy of these agents in COVID-19 patients.

Main Results:

• A broad range of antirheumatic drugs, including hydroxychloroquine, chloroquine, colchicine, calcineurin inhibitors, glucocorticoids, cytokine inhibitors (anti-TNF-α, anti-IL-6, anti-IL-1), JAK inhibitors, CTLA4 blockade agents, and PDE4 inhibitors, have been explored for COVID-19.
• The efficacy and safety profiles of these agents vary depending on the stage of COVID-19 and individual patient factors.
• Early viral inhibition and later immunosuppression are key therapeutic strategies informed by drug mechanisms.

Conclusions:

• Antirheumatic drugs offer diverse mechanisms for targeting COVID-19, from direct viral inhibition to modulating the host immune response.
• Further research is needed to optimize the use of these agents, considering disease phase and patient-specific characteristics.
• The repurposing of antirheumatic drugs presents a promising avenue for COVID-19 management.