Biological Therapies and Immunomodulators: Implications in COVID-19

The novel coronavirus disease 2019 is caused by coronavirus and has been seen to cause fatal pneumonia complicated by severe respiratory distress syndrome. Until February 22, 2022, according to the Ministry of Health and Family Welfare, Government of India, there were 181,075 active COVID cases with 4,218,510 discharged patients and 512,344 deaths. As a part of primary prevention, vaccines have been launched, administrated, and under development along with several drugs that are being investigated for treatment and prophylaxis in COVID-19 infection. The World Health Organization conducted SOLIDARITY, a vast scale study and laid down names of potential drugs that can be used in the management of COVID-19 infection including chloroquine (CQ) phosphate, hydroxychloroquine (anti-malarial) Remdesivir, Lopinavir-Ritonavir with or without interferon (anti-HIV), and convalescent plasma therapy. It has also been known that coronavirus has inflammatory pathogenesis which is responsible for the cytokine storm especially in individuals that are susceptible and with coexisting morbidities. This has led to the consideration of anti-inflammatory cytokine drugs including Anakinra and Tocilizumab, the efficacy of which has also been studied in the management of COVID-19 infection. The current evidence of efficacy regarding two particular approaches to the management of COVID-19 are being elaborated in this review article: Immunomodulators and biological therapy. The article critically discusses therapeutic effectiveness and efficacy of immunomodulator drugs for the management of COVID-19 including CQ, 2-deoxy-d-glucose, and biological therapies such as Tocilizumab, zinc, interferon, plasma therapy, and monoclonal antibodies. In addition, immune-altering conditions related to rheumatology and especially tuberculosis has been discussed to a certain need for change in the management of both.