Table 2.
Immune-modulating panel recommended by the NIH for COVID-19 treatment
| Category | Name | General mechanism | Recommendationa |
|---|---|---|---|
| Anti-inflammatory | Colchicine |
Reduces chemotaxis of neutrophils Inhibits inflammasome signalling Decreases inflammatory cytokine production |
Not recommended, except in clinical trials |
| Anti-inflammatory | Fluvoxamine | Decreases inflammatory cytokine production | Insufficient evidence |
| Anti-inflammatory: corticosteroid | Dexamethasone (systemic) | Systemic mitigation of inflammation | For use in hospitalized patients with COVID-19 who require mechanical ventilation or oxygen support |
| Anti-inflammatory: corticosteroid |
Prednisone Methylprednisolone Hydrocortisone |
Systemic mitigation of inflammation | For use as an alternative to dexamethasone, in the case that it is unavailable |
| Anti-inflammatory: corticosteroid | Budesonide (inhaled) | Localized mitigation of inflammation (lung) | Insufficient evidence |
| Cytokine inhibitor | Anakinra | Inhibits IL-1 | Insufficient evidence |
| Cytokine inhibitor | Canakinumab | Inhibits IL-1 | Not recommended, except in clinical trials |
| Cytokine inhibitor | Siltuximab | Inhibits IL-6 | Not recommended, except in clinical trials |
| Cytokine inhibitor | Tocilizumab | Inhibits IL-6 | For use in combination with systemic corticosteroids for hospitalized patients with severe COVID-19 who have rapidly increasing oxygen requirements and increased markers of inflammation |
| Cytokine inhibitor | Sarilumab | Inhibits IL-6 | For use as an alternative to tocilizumab, in the case that it is unavailable |
| Cytokine inhibitor |
Gimsilumab Lenzilumab Namilumab Otilimab Mavrilimumab |
Inhibits granulocyte-macrophage colony-stimulating factor | Insufficient evidence |
| Kinase inhibitor | Baricitinib | Inhibits JAK1 and JAK2 | For use as second immunomodulatory drug in hospitalized patients on dexamethasone with rapidly increasing oxygen requirements and systemic inflammation |
| Kinase inhibitor | Tofacitinib | Inhibits JAK1, JAK2 and JAK3 | For use as an alternative to baricitinib, in the case that it is unavailable or unfeasible |
| Kinase inhibitor | Ruxolitinib | Inhibits JAK1 and JAK2 | JAK inhibitors other than baricitinib or tofacitinib are not recommended, except in clinical trials |
| Immunoglobulin | Non-SARS-CoV-2-specific intravenous immunoglobulin | General suppression and/or modification of the inflammatory response | Not recommended, except in clinical trials |
JAK, Janus kinase. aNIH COVID-19 treatment recommendations176.