Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is associated with higher concentrations of pro-inflammatory cytokines which leads to lung damage, respiratory failure, and resultant increased mortality. Immunomodulatory therapy has the potential to inhibit cytokines and quell the immune dysregulation. Controversial data found improved oxygenation after treatment with tocilizumab, an IL-6 inhibitor, sparking a wave of interest and resultant clinical trials evaluating immunomodulatory therapies. The purpose of this article is to assess potential pro-inflammatory targets and review the safety and efficacy of immunomodulatory therapies in managing patients with acute respiratory distress syndrome associated with COVID-19.

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SARS-CoV-2 leads to ALI and ARDS with increased mortality. Immunomodulatory therapies have the potential to inhibit cytokines, but the role of elevated cytokines with lung pathology is unclear. The overall lack of evidence and recommendations has forced practitioners to use their own judgment regarding use of immunomodulatory therapy. We are hopeful that as clinical trial data become available their role in managing patients with COVID-19 will emerge. For now, available evidence suggests these treatment options be reserved for use in critically ill COVID-19 patients enrolled in clinical trials. Due to the potential adverse effects, risks and benefits must be weighed and proper screening completed prior to use.

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