{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,17]],"date-time":"2026-02-17T12:37:15Z","timestamp":1771331835664,"version":"3.50.1"},"reference-count":62,"publisher":"BMJ","issue":"3","license":[{"start":{"date-parts":[[2021,10,31]],"date-time":"2021-10-31T00:00:00Z","timestamp":1635638400000},"content-version":"unspecified","delay-in-days":30,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["RMD Open"],"accepted":{"date-parts":[[2021,10,12]]},"published-print":{"date-parts":[[2021,10]]},"abstract":"<jats:sec>\n                  <jats:title>Objective<\/jats:title>\n                  <jats:p>To update the EULAR 2020 systematic literature review (SLR) on efficacy and safety of immunomodulatory agents in SARS-CoV-2 infection.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Methods<\/jats:title>\n                  <jats:p>As part of a EULAR taskforce, a systematic literature search update was conducted from 11 December 2020 to 14 July 2021. Two reviewers independently identified eligible studies and extracted data on efficacy and safety of immunomodulatory agents used therapeutically in SARS-CoV-2 infection at any stage of disease. The risk of bias (RoB) was assessed with validated tools.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>Of the 26\u2009959 records, 520 articles were eligible for inclusion. Studies were mainly at high or unclear RoB. New randomised controlled trials (RCTs) on tocilizumab clarified its benefit in patients with severe and critical COVID-19, mainly if associated with glucocorticoids. There are emergent data on the usefulness of baricitinib and tofacitinib in severe COVID-19. Other therapeutic strategies such as the use of convalescent plasma and anti-SARS-CoV-2 monoclonal antibodies showed efficacy in subjects not mounting normal anti-SARS-CoV-2 antibody responses.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusion<\/jats:title>\n                  <jats:p>This new SLR confirms that some immunomodulators (tocilizumab and JAK inhibitors) have a role for treating severe and critical COVID-19. Although better evidence is available compared with the previous SLR, the need of RCT with combination therapy (glucocorticoids+anti-cytokines) versus monotherapy with glucocorticoids still remains alongside the need for standardisation of inclusion criteria and outcomes to ultimately improve the care and prognosis of affected people. This SLR informed the 2021 update of the EULAR points to consider on the use of immunomodulatory therapies in COVID-19.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1136\/rmdopen-2021-001899","type":"journal-article","created":{"date-parts":[[2021,11,1]],"date-time":"2021-11-01T13:17:41Z","timestamp":1635772661000},"page":"e001899","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":10,"title":["Immunomodulatory therapies for the treatment of SARS-CoV-2 infection: an update of the systematic literature review to inform EULAR points to consider"],"prefix":"10.1136","volume":"7","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-1105-5640","authenticated-orcid":false,"given":"Alessia","family":"Alunno","sequence":"first","affiliation":[{"name":"Internal Medicine and Nephrology Unit, Department of Life, Health & Environmental Sciences, University of L'Aquila, L'Aquila, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6008-503X","authenticated-orcid":false,"given":"Aur\u00e9lie","family":"Najm","sequence":"additional","affiliation":[{"name":"Institute of Infection, Immunity and Inflammation, College of Medical Veterinary and Life Sciences, University of Glasgow, Glasgow, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4244-5417","authenticated-orcid":false,"given":"Xavier","family":"Mariette","sequence":"additional","affiliation":[{"name":"Department of Rheumatology, Universit\u00e9 Paris-Saclay, Assistance Publique-H\u00f4pitaux de Paris, H\u00f4pital Bic\u00eatre, INSERM UMR1184, Le Kremlin-Bic\u00eatre, France"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2406-161X","authenticated-orcid":false,"given":"Gabriele","family":"De Marco","sequence":"additional","affiliation":[{"name":"Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds & The NIHR Leeds Biomedical Research Centre, Chapel Allerton Hospital, Leeds, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jenny","family":"Emmel","sequence":"additional","affiliation":[{"name":"Library & Evidence Research Centre, Medical Education, Leeds Teaching Hospitals NHS Trust, Leeds UK, Leeds, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Laura","family":"Mason","sequence":"additional","affiliation":[{"name":"Library & Evidence Research Centre, Medical Education, Leeds Teaching Hospitals NHS Trust, Leeds UK, Leeds, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Dennis G","family":"McGonagle","sequence":"additional","affiliation":[{"name":"Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds & The NIHR Leeds Biomedical Research Centre, Chapel Allerton Hospital, Leeds, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8411-7972","authenticated-orcid":false,"given":"Pedro M","family":"Machado","sequence":"additional","affiliation":[{"name":"National Institute for Health Research (NIHR) University College London Hospitals (UCLH) Biomedical Research Centre (BRC), University College London Hospitals (UCLH) NHS Foundation Trust, London, UK"},{"name":"Department of Rheumatology, Northwick Park Hospital, London North West University Healthcare NHS Trust, London, UK"},{"name":"Centre for Rheumatology & Department of Neuromuscular Diseases,University College London, London, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[2021,11,1]]},"reference":[{"key":"2025090313375320000_7.3.e001899.1","doi-asserted-by":"crossref","unstructured":"Alunno A , Najm A , Mariette X . 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