Table 2 Immune-modulating panel recommended by the NIH for COVID-19 treatment
Category | Name | General mechanism | Recommendationa |
|---|---|---|---|
Anti-inflammatory | Colchicine | Reduces chemotaxis of neutrophils Inhibits inflammasome signalling Decreases inflammatory cytokine production | Not recommended, except in clinical trials |
Anti-inflammatory | Fluvoxamine | Decreases inflammatory cytokine production | Insufficient evidence |
Anti-inflammatory: corticosteroid | Dexamethasone (systemic) | Systemic mitigation of inflammation | For use in hospitalized patients with COVID-19 who require mechanical ventilation or oxygen support |
Anti-inflammatory: corticosteroid | Prednisone Methylprednisolone Hydrocortisone | Systemic mitigation of inflammation | For use as an alternative to dexamethasone, in the case that it is unavailable |
Anti-inflammatory: corticosteroid | Budesonide (inhaled) | Localized mitigation of inflammation (lung) | Insufficient evidence |
Cytokine inhibitor | Anakinra | Inhibits IL-1 | Insufficient evidence |
Cytokine inhibitor | Canakinumab | Inhibits IL-1 | Not recommended, except in clinical trials |
Cytokine inhibitor | Siltuximab | Inhibits IL-6 | Not recommended, except in clinical trials |
Cytokine inhibitor | Tocilizumab | Inhibits IL-6 | For use in combination with systemic corticosteroids for hospitalized patients with severe COVID-19 who have rapidly increasing oxygen requirements and increased markers of inflammation |
Cytokine inhibitor | Sarilumab | Inhibits IL-6 | For use as an alternative to tocilizumab, in the case that it is unavailable |
Cytokine inhibitor | Gimsilumab Lenzilumab Namilumab Otilimab Mavrilimumab | Inhibits granulocyte-macrophage colony-stimulating factor | Insufficient evidence |
Kinase inhibitor | Baricitinib | Inhibits JAK1 and JAK2 | For use as second immunomodulatory drug in hospitalized patients on dexamethasone with rapidly increasing oxygen requirements and systemic inflammation |
Kinase inhibitor | Tofacitinib | Inhibits JAK1, JAK2 and JAK3 | For use as an alternative to baricitinib, in the case that it is unavailable or unfeasible |
Kinase inhibitor | Ruxolitinib | Inhibits JAK1 and JAK2 | JAK inhibitors other than baricitinib or tofacitinib are not recommended, except in clinical trials |
Immunoglobulin | Non-SARS-CoV-2-specific intravenous immunoglobulin | General suppression and/or modification of the inflammatory response | Not recommended, except in clinical trials |
