A guide to immunotherapy for COVID-19

This Review aims to support clinical decision-making by providing an overview of the evidence for immunotherapy strategies in patients with COVID-19. Immune dysregulation is an important component of the pathophysiology of COVID-19. A large body of literature has reported the effect of immune-based therapies in patients with COVID-19, with some remarkable successes such as the use of steroids or anti-cytokine therapies. However, challenges in clinical decision-making arise from the complexity of the disease phenotypes and patient heterogeneity, as well as the variable quality of evidence from immunotherapy studies. This Review aims to support clinical decision-making by providing an overview of the evidence generated by major clinical trials of host-directed therapy. We discuss patient stratification and propose an algorithm to guide the use of immunotherapy strategies in the clinic. This will not only help guide treatment decisions, but may also help to design future trials that investigate immunotherapy in other severe infections.

Automated summary

This review provides an overview of the evidence for immunotherapy strategies in COVID-19 patients, aiming to support clinical decision-making. Immune dysregulation plays a crucial role in the pathophysiology of COVID-19. Immune-based therapies, such as steroids or anti-cytokine therapies, have shown remarkable successes in treating COVID-19 patients. However, the complexity of disease phenotypes, patient heterogeneity, and variable quality of evidence from immunotherapy studies pose challenges to clinical decision-making. This review summarizes the evidence generated by major clinical trials of host-directed therapy and proposes an algorithm for guiding the use of immunotherapy strategies in the clinic, which can not only guide treatment decisions but also inform future trials investigating immunotherapy in severe infections.