anti-rheumatic drugs as potential anti-inflammatory, immunomodulatory agents against covid-19: a systematic review

Background: the effective responses of both innate and adaptive immunity are crucial in combating novel coronavirus-2 infection. an excessive response may lead to cytokine storm, which is a challenging problem in therapeutic strategies. methods: a systematic review was carried out by searching ovid medline, pubmed, google scholar, and cochrane library databases from inception, for anti-inflammatory and immunomodulatory drugs against coronavirus disease 2019 (covid-19). results: the results of the effectiveness of hydroxychloroquine are just like a sinusoidal diagram and in a state of ambiguity. thalidomide was effective in some cases but has not yet been proven. low-dose corticosteroids may be effective in the early stages of the illness as a bridge. there is no evidence of benefits or adverse outcomes for the use of non-steroidal anti-inflammatory drugs and cyclosporine-a. in some critically ill patients, interleukin-6 (il-6) and il-1 blockers and to some extent, tumor-necrosis-factor-α and janus-kinase inhibitors are useful. finally, high-dose intravenous immunoglobulin reversed the deterioration of patients in most trials. conclusion: one strategy behind the treatments for covid-19 is based on breaking the cytokine storm. although avoiding the suppression of anti-viral immunity is crucial by choosing the weaker and more selective anti-inflammatories, some strategies are kept for hyper-inflammatory situations. scheduling of treatment is also important. although low-dose steroids may be effective in the early stages of the illness, “tocilizumab” is more effective in severe situations, when the il-6 level is high and other drugs are ineffective. therefore, consideration should be given to each patient separately.