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. 2021 Apr 19:1–17. doi: 10.1080/14787210.2021.1915129

Table 1.

Anti-inflammatory agents explored for management of COVID-19

Drug Class Drug/Monoclonal antibody Mechanism of Action Conventional Use Dose in COVID-19 Inclusion criteria for administration Effects observed – % of patients Limitations Reference
IL-6 inhibitors Tocilizumab Binds to both trans-membrane receptor (mIL-6 R) and soluble bound receptor (sIL-6 R) and blocks both classic and trans-signaling pathways of IL-6 Rheumatoid arthritis
Juvenile idiopathic arthritis
Crohn’s disease
400/800 mg
once or twice
(Intravenous infusion)
High level of IL-6 (> 40 pg/mL)
Increased D-dimer and ferritin
Progressively increased fibrinogen
Temperature returned to normal
Improved oxygenation – 75%
Normalized % of peripheral lymphocytes – 52.6%
Improved respiratory function
Absorption of primary lesions, decreased lung opacity – 90.5%
Decreased IL-6 levels
Contraindicated in patients with tuberculosis
Hepatotoxicity, hypertriglyceridemia, diverticulitis
Inhibition of both protective and inflammatory pathways of IL-6
[89–95]
Siltuximab Binds to both mIL-6 R and sIL-6 R
Inhibits IL-6 dimerization with gp130, causing inactivation of downstream signaling
Forms high-affinity complexes with soluble human IL-6
Castleman’s disease 700–1200 mg
Single dose
(intravenous infusion)
Patients with diagnosed ARDS
Patients requiring ventilation
High levels of IL-6
Reduction of serum CRP to normal range – 76.2%
Reduction in need for ventilation – 33%
Stabilized condition – 43%
Worsened condition (related to mortality or cerebrovascular events) and intubation required
Side effects – hypertension, fatigue, nausea, neutropenia, infection
Contraindicated in patients having diminished cytochrome P450 activity
[96–98]
JAK/STAT inhibitors Baricitinib Selective inhibition of JAK1 and JAK2 kinase activity
Inhibits adaptor associated protein kinase 1 (AAK1)
Binds to cyclin G-associated kinase (GAK)
Rheumatoid arthritis
Psoriatic arthritis
2–4 mg
Once daily for 10 days – 2 weeks
(oral)
Moderate to severe COVID-19
Hospitalized patient
SpO2 ≤ 94% on room air
Required mechanical ventilation
Temperature ≥ 36.6°C armpit
Improved respiratory function
Decreased cytokine storm
Reduction of SARS-CoV-2 particle entry in host lung cells
Decreased IL-6 and GM-CSF levels
Inhibition of IFN-γ
Ongoing clinical trials
[99–101]
IL-1 inhibitors Anakinra Prevents binding of IL-1α and IL-1β, thus reducing availability of ligand for endogenous IL-1 receptor Rheumatoid arthritis
Macrophage activation syndrome
Hemophagocytic lymphohistiocytosis
Still’s disease
Cryopyrin associated periodic syndrome
5 mg/kg twice a day
(intravenous – high dose)
100–200 mg twice a day
(subcutaneous – low dose)
Moderate to severe ARDS and COVID-19
Hyperinflammation (CRP ≥ 100 mg/L, Ferritin ≥ 900 ng/mL)
Noninvasive ventilation required
Presence of severe sepsis
Decreased CRP and improved respiratory function (72%)
Reduced mortality
Reduced need for mechanical ventilation
Associated with injection site reactions
Majorly well tolerated
No beneficial effects observed in patients having thromboembolism
[102–108]