The pandemic has imposed a speed on scientific research that has never been seen before. In the space of a few months, an impressive body of results was produced, millions of data were collected, hundreds of studies designed and initiated. And even the recommendations that scientific societies formulate on the basis of this evidence have had to update at a faster rate than usual. This is why, just under a year after the first draft, the updates of the Eular Recommendations, the European rheumatology society, on effective rheumatological drugs in patients with Covid-19 are now arriving. The project was conceived and coordinated by Xavier Mariette, rheumatologist at the University of Paris-Saclay.
In the months of the emergency much has been said about the possible use of these medicines to counteract some aspects of Covid-19, and some studies have been started to try to verify these hypotheses. Today, about two years after the start of the pandemic, something precise and, above all, scientifically proven can be affirmed. For example, as already written in the first Recommendations, the class of drugs on which there is greater evidence of a positive action is that of corticosteroids, in particular dexamethasone: a powerful drug that manages to calm the inflammatory cascade that develops a once the virus has started to replicate inside the body, therefore indicated for the treatment of severe forms of Covid-19.
Compared to the first version of the Recommendations, however, the update brings a novelty in clinical practice by indicating how, in specific cases, a second drug, tocilizumab, must be added to dexamethasone. “When we met last July to analyze the new published studies, we observed that a lot had been done”, explains Alessia Alunno, rheumatologist at the UOC of Internal Medicine and Nephrology, MESVA Department, University of L’Aquila, and before signature of the literature review and Recommendations published in Annals of the Rheumatic Diseases. “In particular, a series of studies had shown that by adding tocilizumab, a drug that we rheumatologists have been using for years, to dexamethasone, it is possible to slow down the progression of the disease and reduce mortality in a specific group of patients, those who need oxygen therapy. non-invasive or mechanical ventilation “. Results that even the recommendations of the World Health Organization had considered, indicating these two drugs, dexamethasone and tocilizumab, as the cornerstone of immunomodulatory therapy. In this same category of patients, the experts add, two other drugs have also shown promising results, namely baricitinib and tofacitinib.
Indications also for hyperimmune plasma and antibodies directed against Sars-Cov-2: these are drugs useful in the earliest stages of infection, within 5-7 days from the appearance of the first symptoms, or, in the case of antibodies anti-Sars-CoV-2, in patients at high risk of developing the disease. In particular, hyperimmune plasma appears to have some efficacy in patients with immune response defects and with recent onset symptoms. “It is also recommended to choose the anti-Sars-CoV-2 monoclonal antibodies by looking at the distribution of the virus variants and on the basis of the efficacy of the individual products on the individual variants,” adds Alunno.
Finally, experts comment on some drugs, anakinra and colchicine, for which studies are underway but the available data are not sufficient. “In this case we could not make a recommendation in favor of their use because the positive data are not yet robust enough,” explains Alunno. “The information is starting to accumulate but it is not clear enough, we need time and further studies”. The research is running but it is good to stick to concrete evidence from high quality clinical studies.
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