4.5 Interferon-α and -β
Human immune system fight against viral infections by release interferon
(Alpha, Beta), which inhibits the proliferation of viruses by inducing
the synthesis of antiviral proteins. Interferon drugs are used as a
broad-spectrum antiviral drug in clinical practice. Previous study has
demonstrated that interferon-α and -β showed antiviral activity against
MERS (Morra et al., 2018; Stockman, Bellamy, & Garner, 2006). A study
demonstrated the antiviral effects of interferon-α2β and ribavirin on
the replication of nCoV isolates hCoV-EMC / 2012 in Vero and LLC-MK2
cells (Falzarano et al., 2013). National Health Commission issued the
“Diagnosis and treatment protocol for novel coronavirus pneumonia
(version 7)”, which recommend that interferon alpha is taken by
atomization inhalation. Adults should take 50μg in 2ml of sterile water
via injection each time twice a day. Interferon alpha can be used as a
novel drug to improve virus clearance effect of the respiratory mucosa
of patients (Commission, 2020). Currently, a multi-center,
blank-controlled, randomized, open, multi-stage clinical study is
ongoing aimed at evaluating the efficacy and safety of recombinant human
interferon α1β in treating patients with COVID-19 in Wuhan (NCT04293887)
(ClinicalTrails.gov, 2020). However, there is no data on animal or human
studies to recommend their clinincal use to combat COVID-19. Further
verification of its safety and efficacy is required.
4.6 Corticosteroids
Acute lung injury (ALI) or ARDS was seen in cases of late phase severe
SARS. Corticosteroids were adopted to suppress lung inflammation in MERS
and SARS due to their immunomodulatory properties. Some clinical trials
suggested that high-dose of corticosteroids reduced mortality of SARS
without increasing the risk of life-threatening complications (Ho et
al., 2003; Sung et al., 2004; Zhong, 2004). A retrospective study on
adverse outcomes of SARS patients with hormone therapy showed that
patients developed adverse reactions, and hormone therapy increased the
risk of admission to the intensive care unit or death by 20.7 times
(Auyeung et al., 2005). Elsewhere, a retrospective study showed that
appropriate use of hormones in patients with severe SARS can reduce
mortality and shorten hospital stay. Moreover, they found that hormones
did not cause serious secondary lower respiratory tract infections and
other complications (R. C. Chen et al., 2006). In February, 7, 2020, an
article published on the Lancet suggested that it is insufficient
for current clinical evidence to support the hormone therapy in treating
ALI resulting from SARS-CoV-2 (Russell, Millar, & Baillie, 2020).
Following the epidemic of SARS, the efficacy and safety of
glucocorticoids is considerably understood. Corticosteroids should be
used with caution for patients with COVID-19. Furthermore, physicians
should strictly follow the indications, drug dosage and course of
treatment. However, for critically ill patients with rapid progression,
appropriate use of corticosteroids in addition to a ventilator support
should be measured to prevent the progression of acute respiratory
distress syndrome.