Evolving therapeutic strategies for severe fever with thrombocytopenia syndrome: from past to future

Severe fever with thrombocytopenia syndrome (SFTS) is a hemorrhagic fever caused by Bandavirus dabieense. SFTS was first identified in China in 2009 and has been reported since then in neighboring countries and regions. The clinical manifestations of SFTS include fever, thrombocytopenia, and leukocytopenia and are often accompanied by gastrointestinal symptoms and bleeding. In severe cases, patients experience life-threatening immune damage and cytokine storms. Despite nearly 15 years since its discovery, no effective vaccine has been approved. However, significant progress has been achieved in elucidating the mechanisms of host immune responses, accompanied by the clinical implementation of various therapeutic agents. This article provides a comprehensive review of commonly utilized treatments supported by current clinical evidence. Favipiravir has advantages over ribavirin in terms of viral clearance and prognosis. Conventional immunomodulators like interferon, intravenous immunoglobulin, and glucocorticoids have limited effects and may even worsen conditions, whereas novel immunomodulators such as tocilizumab and ruxolitinib have shown potential for improving prognosis. Prophylactic platelet transfusions neither prevent bleeding nor improve clinical outcomes. Additionally, plasma exchange, calcium channel blockers, and arginine can improve laboratory values and expedite viral clearance. In the future, screening Food and Drug Administration-approved drugs and conducting multiomics analyses may lead to the discovery of new effective therapeutic options.