Cytokine storm and probable role of immunoregulatory drugs in COVID-19: a comprehensive review

The coronavirus disease 2019 (COVID-19) is currently the most important global health problem. Due to its pandemic state and high mortality rate, it is critical to find useful interventions that reduce the mortality rate and boost patient survival. Since there is no specific antiviral treatment for the disease and given the growing amount of data about the role of the inflammatory response and cytokine storm in increased disease severity, we evaluated the mechanisms and possible positive effects of some specific anti-inflammatory drugs on the disease course of COVID-19 and examined some suggested treatments in the form of a scoping review article. It is important to select patients who may benefit from these treatments without inflicting any serious adverse effects. In our view, in approaching COVID-19 patients, we should consider the severity of the body’s inflammatory response. Mild cases may not require additional anti-inflammatory treatment or at least should be treated with safer immunoregulatory drugs such as chloroquines, whereas in severe cases with an overactive immune response evidenced by high serum inflammatory marker levels (TNF, ESR, CRP, WBC count, LDH, ferritin) and severe lung involvement in chest images, stronger immunoregulatory drugs (targeted immunotherapy) such as TNF and kinase inhibitors may be considered as adjunctive treatments in combination with antiviral drugs. However, further precisely designed studies are needed to confirm the therapeutic effect and safety of each of these anti-inflammatory drugs in COVID-19 patients and to determine their optimal dose, route of administration, and possible side effects.