Is there a role for immune-enhancing therapies for acutely ill patients with coronavirus disease 2019?

PURPOSE OF REVIEW: Although the so-called cytokine storm has been early described and related to a dramatic evolution in severe COVID-19 patients, it soon became clear that those patients display clinical and biological evidence of an immunosuppressive state characterized, among other, by a profound lymphopenia. The negative role of this immune suppression on the outcome raises the question on immune therapies that might improve patient's condition. RECENT FINDINGS: Important positive effects of active immune therapies, such as IL-7 or thymosin-α are already described and warrant confirmation in larger prospective trials. For other therapies, such as interferons, firm conclusions for critically ill COVID-19 patients are lacking as those patients were often excluded from the published trials. Treatment with immunoglobulins or convalescent plasma is a passive strategy to provide specific immunity. Unfortunately, results from large RCTs do not support their use presently. SUMMARY: In this article, we provide a review on active and passive immune boosting strategies that might help treating the most severe COVID-19 patients. We mainly focus on active strategies that include IL-7, thymosin-α, interferons, and vitamin D. Although some positive effects are described, they certainly warrant confirmation in large randomized controlled trials.

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Wittebole, X., Montiel, V., & Mesland, J.-B. (2021). Is there a role for immune-enhancing therapies for acutely ill patients with coronavirus disease 2019? Current Opinion in Critical Care, 27(5), 480-486. https://doi.org/10.1097/MCC.0000000000000862 (Original work published 2021)