Beyond the use of specific anti-viral products, many drugs commonly used in the treatment of RA have been proposed as possible therapies for COVID-19 as a consequence of the increased knowledge about the pathophysiology of the infection (Table 1 ).
Table 1 Potential role of anti-rheumatic drugs in COVID-19 infection.
PROS CONS
Chloroquine Anti-viral effect (increase of endosomal pH required for virus/cell fusion, inhibition of toll-like receptor activity, interference with terminal glycosylation of the cellular receptor ACE 2) –
Hydroxychloroquine
IL-6 inhibitors Treatment of cytokine storm manifestations during ARDS Lack of definite criteria to identify patients to be treated
Potential community-acquired pneumonia due to immunosuppression
Baricitinib Interference with viral penetration into the cell by blocking NAK-mediated endocytosis Impairment of IFN anti-viral response
Treatment of cytokine storm manifestations during ARDS Increased risk of secondary HZV infections
TNF-inhibitors Interference with viral penetration into the cell Slight increase in viral infection risk
NSAIDs – Facilitation of viral penetration by overexpression of ACE2
Delay in diagnosis due to fever masking
Corticosteroids – Increased risk of viral infection
Increased mortality and risk of secondary bacterial or fungal infection
ACE2 = angiotensin converting enzyme 2, ARDS = acute respiratory distress syndrome, NAK = numb-associated kinase; HZV = Herpes Zoster virus,
IFN = interferon, NSAIDs = nonsteroidal anti-inflammatory drugs.