Perspectives on the application of immunotherapy in COVID-19: systematic review
INTRODUCTION: The Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) appeared in December 2019 spreading abruptly across the globe. With the potential for worsening and death, SARS-CoV-2 infection leads to extensive clinical manifestations, from asymptomatic/oligosymptomatic cases to pneumonia and severe acute respiratory syndrome (SARS), which together represent the coronavirus disease 2019 (COVID-19). Notably, the current approach to managing COVID-19 focuses on supportive care. Passive antibody therapy can be considered as a way to limit the epidemics of COVID-19, whereas immunotherapy is considered an effective method for the clinical treatment of infectious diseases. AIM: To present the main immunotherapeutic approaches under study in face of COVID-19. MATERIAL AND METHODS: It is a retrospective study, with a systematic review based on the search for publications indexed in the EMBASE, PubMed and SCOPUS databases, available for download, written in English and published in the 2019-2020 biennium, aided by the PRISMA Protocol (Preferred Reporting Items for Systematic Reviews and Meta-Analyzes). The terms "COVID-19" and "Immunotherapy" were used as search descriptors. RESULTS: In view of the analysis of the 28 selected studies, it was exposed that the main immunotherapeutic approaches to COVID-19 are the use of monoclonal antibodies, mentioned in 92.8% (n=26) of the articles. In this scenario, 80.7% of the studies (n=21) address the use of the monoclonal antibody Tocilizumab (TCZ), this therapeutic agent acts on Interleukin 6 (IL-6). Clinical experiences suggest that IL-6 is one of the most important molecules involved in COVID-19 induced cytokine storms. In this way, studies show that the TCZ applied to patients in severe stages of COVID-19 leads to significant improvement in the clinical picture, exhausting the need for oxygenation, and the radiographs showed linear scars, consistent with the cure of pneumonia by COVID-19. However, patients with allergic reactions, tuberculosis and other active infections are contraindicated. CONCLUSION: In this perspective, the main immunotherapeutic approach is the treatment via monoclonal antibodies, especially TCZ, to present significant benefits. The use of immunotherapy has shown positive results while it seeks to neutralize the infection by interrupting the life cycle of the viral particle and combating the consequences of this infection, such as the cytokine storm.
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