After reviewing antiviral drugs (Brüssow Environmental Microbiology 2021) the present review summarizes the results of clinical trials with host-modifying drugs in COVID-19 patients. Clinical benefits were observed with different immunomodulators. The variable outcomes of trials with the interleukin 6 receptor inhibitor tocilizumab demonstrated that treatment benefits might only be present in specific subgroups of patients or in specific infection stages. A meta-analysis of trials with the interleukin 1 receptor antagonist anakinra showed a survival benefit only in patients with hyperinflammation. The Janus kinase inhibitor baricitinib is an anti-inflammatory treatment that showed a clinical benefit in hospitalized patients who do not yet need supplementary oxygen. In contrast, the corticosteroid dexamethasone showed mortality reducing effects that were limited to patients on ventilation or in need of supplementary oxygen. Therapeutic dose of anticoagulation met the criteria for inferiority in severe cases, but showed a small survival benefit in non-severe COVID-19 patients. Large trials with colchicine showed a small or no survival benefit. Azithromycin, an antibiotic with immunomodulatory activity, showed no effects in numerous clinical trials. The trials showed a clear need for new drugs instead of repurposed drugs and drugs that specifically target the SARS-CoV-2 virus or the pathology developing in COVID-19 patients.

中文翻译：

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针对 COVID-19 的宿主修饰药物：取得了一些成功，但尚未取得突破

在审查了抗病毒药物（Brüssow Environmental Microbiology 2021）之后，本审查总结了在 COVID-19 患者中使用宿主修饰药物的临床试验结果。使用不同的免疫调节剂观察到临床益处。白细胞介素 6 受体抑制剂托珠单抗试验的可变结果表明，治疗益处可能只存在于特定的患者亚组或特定的感染阶段。一项对白细胞介素 1 受体拮抗剂阿那白滞素试验的荟萃分析显示，仅对过度炎症患者有生存益处。Janus 激酶抑制剂 baricitinib 是一种抗炎治疗药物，在尚不需要补充氧气的住院患者中显示出临床益处。相比之下，皮质类固醇地塞米松显示出降低死亡率的作用，但仅限于通气或需要补充氧气的患者。治疗剂量的抗凝剂在严重病例中符合劣效标准，但在非重症 COVID-19 患者中显示出小的生存获益。使用秋水仙碱进行的大型试验显示，生存获益很小或没有。阿奇霉素是一种具有免疫调节活性的抗生素，在许多临床试验中没有显示出效果。试验表明，显然需要新药，而不是重新利用药物和专门针对 SARS-CoV-2 病毒或 COVID-19 患者病理发展的药物。但在非重症 COVID-19 患者中显示出小的生存获益。使用秋水仙碱进行的大型试验显示，生存获益很小或没有。阿奇霉素是一种具有免疫调节活性的抗生素，在许多临床试验中没有显示出效果。试验表明，显然需要新药，而不是重新利用药物和专门针对 SARS-CoV-2 病毒或 COVID-19 患者病理发展的药物。但在非重症 COVID-19 患者中显示出小的生存获益。使用秋水仙碱进行的大型试验显示，生存获益很小或没有。阿奇霉素是一种具有免疫调节活性的抗生素，在许多临床试验中没有显示出效果。试验表明，显然需要新药，而不是重新利用药物和专门针对 SARS-CoV-2 病毒或 COVID-19 患者病理发展的药物。