Immunomodulators

Corticosteroids
Corticosteroids were widely used for the treatment of SERS-CoV and MERS-CoV and are also used in the management of the current epidemic of 2019-nCoV. However, the interim guidelines by the WHO prohibit the use of routine corticosteroids unless indicated for other clinical ground.[18] Use of corticosteroid is reported to be associated with delayed clearance of viral RNA (both in case of SERS-CoV and MERS-CoV) and other steroid-related complications such as psychosis.[19]

Interferon
Interferons (IFNs) are broad-spectrum antivirals, primarily used in the treatment of hepatitis B. In SARS-CoV patients, compared to ribavirin or interferon (IFN) alone, the benefit was seen on IFN-α + high-dose corticosteroid group.[20] Other observational studies also support these findings and the combined use of IFN-α and corticosteroid (corticosteroid arm n = 13; corticosteroid + IFN-α arm n = 9) showed less disease-associated oxygen saturation impairment.[21] For the treatment of 2019-nCoV (7), IFN-α (5 million U bid inh) is recommended along with lopinavir + ritonavir combination.[17]

Immunoglobulins
In case of critically ill SARS, who show signs of deterioration, further escalation of immunomodulation is indicated and intravenous (i.v.) immunoglobulin may be considered.[22] Patients who show poor response to initial empirical therapy may get benefit from i.v. immunoglobulin.[23]