Weighing the Effects of Immunosuppression for Hyperinflammation in COVID-19

vaccine and virus
The effects of reducing hyperinflammation by immunosuppression has been discussed in this editorial.

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.

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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.