Hazards of the cytokine storm and cytokine-targeted therapy in COVID-19 patients: A Review.

BACKGROUND Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has challenged medicine and healthcare on a global scale. Its impact and frightening mortality rate are in large part attributable to the fact that there is a lack of available treatments. It has been shown that in severely-ill patients, SARS-CoV-2 can lead to an inflammatory response known as cytokine storm, which involves activation and release of inflammatory cytokines in a positive feedback loop of pathogen-triggered inflammation. Currently, cytokine storm is one of the leading causes of morbidity and mortality in SARS-CoV-2, but there is no proven treatment to combat this systemic response. OBJECTIVE To study the cytokine storm response in SARS-CoV-2 and to explore the early treatment options for critically-ill coronavirus disease 2019 (COVID-19) patients in the early stages of the pandemic by reviewing literature. METHODS A literature review was performed from December 1, 2000 to April 4, 2020, to explore and compare therapies that target cytokine storm among SARS-CoV-2 and prior coronavirus cases. RESULTS Thirty-eight eligible studies including 24 systematic reviews, 5 meta-analysis, 5 experimental model studies, 7 cohort studies, and 4 case reports matched criteria. CONCLUSIONS Severity of the cytokine storm, measured by elevated levels of IL1B, IFNγ, IP10, and MCP1, was associated with COVID-19 disease severity. Many treatment options with different targets have been proposed during the early stages of the COVID-19 pandemic, ranging from targeting the virus itself to managing the systemic inflammation caused by the virus and the excessive cytokine response. Among the different agents to manage cytokine storm in COVID-19 patients, there is developing support for convalescent plasma therapy particularly for critically-ill and mechanically ventilated patients who are resistant to antivirals and supportive care. Treatment options that were proposed in the beginning phases of the pandemic were multi-dimensional, and further research is needed to develop a more established treatment guideline. CLINICALTRIAL