Evidence map›Paper›PMID 32256705›Full record

ReviewEcancermedicalscience2020

Associations between immune-suppressive and stimulating drugs and novel COVID-19-a systematic review of current evidence.

Beth Russell, Charlotte Moss, Gincy George, Aida Santaolalla, Andrew Cope, Sophie Papa, Mieke Van Hemelrijck

Registry-linked trialOpen access · goldAbstract readReview
PubMed Full text at PMC Publisher
In one paragraph

Review in Ecancermedicalscience, 2020. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to trial NCT04540926 (Utility of Low Doses of Corticosteroids and Cyclosporine Combined With Enoxaparin, in Patients With COVID-19 Pneumonia at the ISSSTE Regional Hospital, Puebla, During the Contingency Period Due to the SARS-Cov2 Pandemic), which is not on this map. Cited by 255 papers, 10 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
255citing papers in PubMed, 10 pooled it
11.0field-weighted citation impact, top 1% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

NCT04540926 phase1 / phase2unknown statusnot on this map

Utility of Low Doses of Corticosteroids and Cyclosporine Combined With Enoxaparin, in Patients With COVID-19 Pneumonia at the ISSSTE Regional Hospital, Puebla, During the Contingency Period Due to the SARS-Cov2 Pandemic

TypeinterventionalSponsorInstituto de Seguridad y Servicios Sociales de los Trabajadores del EstadoRan2020 to 2020Enrolled200ConditionsCOVID 19 PneumoniaArmsCyclosporin A
3 · Its place in the literature

Who cites it

255 citing papers in PubMed, 10 syntheses or guidelines pooled it, 449 citations in OpenAlex.

  1. Pooled it
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  4. Effect of immunosuppression maintenance in solid organ transplant recipients with COVID-19: Systematic review and meta-analysis.Transplant infectious disease : an official journal of the Transplantation Society · 2021
    Pooled it
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  8. COVID-19 clinical manifestations and treatment strategies among solid-organ recipients: A systematic review of cases.Transplant infectious disease : an official journal of the Transplantation Society · 2020
    Pooled it
  9. Guideline
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195 more citing papers are in PubMed but not listed here.

4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

7 authors at 1 institution in 1 country.

Beth RussellTranslational Oncology and Urology Research, King's College London, London, UK.
Charlotte MossTranslational Oncology and Urology Research, King's College London, London, UK.
Gincy GeorgeTranslational Oncology and Urology Research, King's College London, London, UK.
Aida SantaolallaTranslational Oncology and Urology Research, King's College London, London, UK.
Andrew CopeGuy's and St. Thomas NHS Foundation Trust, London, UK.
Sophie PapaGuy's and St. Thomas NHS Foundation Trust, London, UK.
Mieke Van HemelrijckTranslational Oncology and Urology Research, King's College London, London, UK.
King's College London · GB

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

backgroundCancer and transplant patients with COVID-19 have a higher risk of developing severe and even fatal respiratory diseases, especially as they may be treated with immune-suppressive or immune-stimulating drugs. This review focuses on the effects of these drugs on host immunity against COVID-19.

methodsUsing Ovid MEDLINE, we reviewed current evidence for immune-suppressing or -stimulating drugs: cytotoxic chemotherapy, low-dose steroids, tumour necrosis factorα (TNFα) blockers, interlukin-6 (IL-6) blockade, Janus kinase (JAK) inhibitors, IL-1 blockade, mycophenolate, tacrolimus, anti-CD20 and CTLA4-Ig.

results89 studies were included. Cytotoxic chemotherapy has been shown to be a specific inhibitor for severe acute respiratory syndrome coronavirus in in vitro studies, but no specific studies exist as of yet for COVID-19. No conclusive evidence for or against the use of non-steroidal anti-inflammatory drugs (NSAIDs) in the treatment of COVID-19 patients is available, nor is there evidence indicating that TNFα blockade is harmful to patients in the context of COVID-19. COVID-19 has been observed to induce a pro-inflammatory cytokine generation and secretion of cytokines, such as IL-6, but there is no evidence of the beneficial impact of IL-6 inhibitors on the modulation of COVID-19. Although there are potential targets in the JAK-STAT pathway that can be manipulated in treatment for coronaviruses and it is evident that IL-1 is elevated in patients with a coronavirus, there is currently no evidence for a role of these drugs in treatment of COVID-19.

conclusionThe COVID-19 pandemic has led to challenging decision-making about treatment of critically unwell patients. Low-dose prednisolone and tacrolimus may have beneficial impacts on COVID-19. The mycophenolate mofetil picture is less clear, with conflicting data from pre-clinical studies. There is no definitive evidence that specific cytotoxic drugs, low-dose methotrexate for auto-immune disease, NSAIDs, JAK kinase inhibitors or anti-TNFα agents are contraindicated. There is clear evidence that IL-6 peak levels are associated with severity of pulmonary complications.

Indexed as

adverse eventscancerCOVID-19immune modulationimmune suppression

Identifiers

PMID32256705
PMCPMC7105343
OpenAlexW3013893688

What OpenQuestion holds

Textmetadata
LicenceCC BY
Read underepoch 390

Registered trials

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.