Is There A Role For Immune-Enhancing Therapies For Acutely Ill Patients With Coronavirus Disease 2019?

Purpose of reviewAlthough the so-called cytokine storm has been early described and related to a dramatic evolution in severe COVID-19 patients, it soon became clear that those patients display clinical and biological evidence of an immunosuppressive state characterized, among other, by a profound lymphopenia. The negative role of this immune suppression on the outcome raises the question on immune therapies that might improve patient's condition.Recent findingsImportant positive effects of active immune therapies, such as IL-7 or thymosin-alpha are already described and warrant confirmation in larger prospective trials. For other therapies, such as interferons, firm conclusions for critically ill COVID-19 patients are lacking as those patients were often excluded from the published trials. Treatment with immunoglobulins or convalescent plasma is a passive strategy to provide specific immunity. Unfortunately, results from large RCTs do not support their use presently.SummaryIn this article, we provide a review on active and passive immune boosting strategies that might help treating the most severe COVID-19 patients. We mainly focus on active strategies that include IL-7, thymosin-alpha, interferons, and vitamin D. Although some positive effects are described, they certainly warrant confirmation in large randomized controlled trials.