Immunotherapy in the treatment of covid-19

The high mortality rate in COVID-19 can be explained by the development of a hyperinflammatory syndrome, characterized by a cytokine storm and extensive thrombus formation. The main direction for preventing the development of hyperinflammatory syndrome and reducing mortality from COVID-19 is immune therapy, however, the data on the efficacy and criteria for prescribing immune drugs is very heterogeneous. The purpose of this review is to analyze the results of clinical trials on the use of various types of immune therapy and possible criteria for its prescription. Analysis of literature data showed that the most effective among the existing variants of immune therapy were monoclonal antibodies to IL-6, the use of donor plasma in the early stages of treatment. Janus kinase inhibitors, intravenous immunoglobulin improved the clinical characteristics of patients, but did not affect the mortality rate. An analysis of possible predictor-markers of the development of a cytokine storm revealed an increase in the number of neutrophils > 11 × 10 3 /ml, a decrease in the number of lymphocytes > 1000 × 10 3 /ml, an increase in the level of IL-6 > 24 pg/ml, LDH > 300 IU/L, D-dimer > 1000 ng/ml, and CRP > 10 mg/dL as the most informative and accessible in clinical practice at the moment.