Reducing hyperinflammation by immunosuppression in patients with the novel coronavirus disease 2019 (COVID-19) should be approached with caution, according to correspondence published in The Lancet.1
The rapid spread and high mortality rate of COVID-19 has created an urgent need for the development of an effective treatment strategy. While novel therapeutics and vaccines for COVID-19 are currently being developed, the repurposing of existing medications for the treatment of patients with COVID-19 has also been investigated.
Retrospective analyses of patients with COVID-19 have indicated that systemic inflammation is associated with adverse outcomes, in light of which Mehta and colleagues postulated that cytokine storm syndrome may be fueling some COVID-19 deaths and proposed therapeutic treatment targeting inflammatory processes.2
However, according to the authors of this report, “correlation does not equal causation;” increased inflammation among patients with severe COVID-19 may also be driven by a higher viral burden and consequently, disease severity.
Corticosteroids and Janus kinase inhibitors have been indicated to reduce hyperinflammation, but, on the other hand, they impair type-1 interferon responses against other respiratory viruses.3 As a result, treatment with these pharmacotherapeutics may inhibit host antiviral defenses, delaying viral clearance and exacerbating illness.
Of additional concern, therapeutics that attenuate inflammation and immune responses may promote secondary bacterial infection, which could further complicate treatment and recovery.3
“The decision to pharmacologically immunosuppress [the immune system of] a critically unwell patient with COVID-19 remains a difficult one,” the authors of this editorial noted. “Possible beneficial effects of reducing inflammation should be carefully weighed up against the potential for deleterious impairment of antimicrobial immunity.”
Disclosure: One study author reported affiliations with the pharmaceutical industry. Please see the original reference for a full list of disclosures.
1. Ritchie AI, Singanayagam A. Immunosuppression for hyperinflammation in COVID-19: a double-edged sword? [published March 24, 2020]. Lancet. doi:10.1016/S0140-6736(20)30691-7
2. Mehta PM, McAuley DF, Brown M, Sanchez E, Tattersall RS, Manson JJ. COVID-19: consider cytokine storm syndromes and immunosuppression. Lancet. 2020;395(10229):1033-1034.
3. Singanayagam A, Glanville N, Girkin JL, et al. Corticosteroid suppression of antiviral immunity increases bacterial loads and mucus production in COPD exacerbations. Nat Commun. 2018;9:2229.