Evaluation of the inhaled immunosuppressants effectiveness in the treatment of COVID-19


A hyperimmune response to severe acute respiratory syndrome coronavirus 2 (SARS CoV-2) often leads to severe uncontrolled inflammation in the lungs, complications and death. During the treatment of coronavirus disease 2019 (COVID-19), drugs from different pharmacological groups with different mechanisms of action are used, including immunosuppressants. The most promising of them are monoclonal antibodies and purinergic agents. There are isolated publications about attempts to use “classical” immunosuppressants, cytostatics and calcineurin inhibitors, which are usually used in transplantology and oncology, in the form of inhalations. However, there is no analysis of the effectiveness of using inhalations of various immunosuppressants in the treatment of COVID-19.

The aim is to analyze the use of inhalation of different groups of immunosuppressants in the treatment of COVID-19.

Material and methods. An analysis of 62 full-text literature sources selected from a search of biomedical scientific information databases was conducted, including Index Medicus, PubMed, EMBASE, Cohrane, the Clinical Trials gov registry, and relevant literature related to intellectual property protection.

Results and discussion. An assessment of the effectiveness of various immunosuppressant subgroups effects, including their inhalation administration into the respiratory tract is made. Methods and approaches to their use, advantages and disadvantages are reflected. The feasibility and prospects of their use are determined.

Conclusion. There is no feasibility of using inhaled cytostatics and calcineurin inhibitors for the treatment of COVID-19. Biological drugs are promising, including monoclonal antibodies and agents that stimulate purinoceptors when aerosolized into the lungs.

Keywords:immunosuppressants; inhalations; COVID-19; hyperinflammation; T-regulatory cells

Funding. The study had no sponsor support.

Conflict of interest. The author declares no conflict of interest.

For citation: Kobylyansky V.I. Evaluation of the inhaled immunosuppressants effectiveness in the treatment of COVID-19. Infektsionnye bolezni: novosti, mneniya, obuchenie [Infectious Diseases: News, Opinions, Training]. 2023; 12 (4): 81–9. DOI: https://doi.org/10.33029/2305-3496-2023-12-4-81-89 (in Russian)


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Aleksandr V. Gorelov
Academician of the Russian Academy of Sciences, MD, Head of Infection Diseases and Epidemiology Department of the Scientific and Educational Institute of Clinical Medicine named after N.A. Semashko ofRussian University of Medicine, Ministry of Health of the Russian Federation, Professor of the Department of Childhood Diseases, Clinical Institute of Children's Health named after N.F. Filatov, Sechenov First Moscow State Medical University, Ministry of Health of the Russian Federation, Deputy Director for Research, Central Research Institute of Epidemiology, Rospotrebnadzor (Moscow, Russian Federation)

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