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

The coronavirus disease 2019 (covid-19) is currently the mostimportant global health problem. due to its pandemic state andhigh mortality rate, it is critical to find useful interventions thatreduce the mortality rate and boost patient survival. since thereis no specific antiviral treatment for the disease and given thegrowing amount of data about the role of the inflammatory responseand cytokine storm in increased disease severity, we evaluatedthe mechanisms and possible positive effects of some specificanti-inflammatory drugs on the disease course of covid-19 andexamined some suggested treatments in the form of a scopingreview article. it is important to select patients who may benefitfrom these treatments without inflicting any serious adverseeffects. in our view, in approaching covid-19 patients, we shouldconsider the severity of the body’s inflammatory response. mildcases may not require additional anti-inflammatory treatment orat least should be treated with safer immunoregulatory drugssuch as chloroquines, whereas in severe cases with an overactiveimmune response evidenced by high serum inflammatory markerlevels (tnf, esr, crp, wbc count, ldh, ferritin) and severe lunginvolvement in chest images, stronger immunoregulatory drugs(targeted immunotherapy) such as tnf and kinase inhibitorsmay be considered as adjunctive treatments in combination withantiviral drugs. however, further precisely designed studiesare needed to confirm the therapeutic effect and safety of eachof these anti-inflammatory drugs in covid-19 patients andto determine their optimal dose, route of administration, andpossible side effects.