CTAG: Immune-modulating agents

Download the Position Statement

(V3.0 30 June 2020)

Key messages

  • A subset of patients with COVID-19 may experience an exaggerated hyperinflammatory response
  • COVID-19 associated hyperinflammation predominantly involves the lung however may progress to secondary haemophagocytic lymphohistocytosis (sHLH) which is a systemic and multi-organ condition with significant morbidity and mortality
  • Consider dexamethasone in adults receiving oxygen therapy, non-invasive or invasive ventilation, or ECMO
  • As far as possible, the use of investigative immunomodulatory medicines should be used in the context of a national priority clinical trial
  • Patients who meet diagnostic criteria for sHLH should be managed within established pathways, guided by a specialist familiar with hyperinflammation
  • Advice on the appropriate use of remdesivir is available at  is available in the CTAG Antivirals position statement
  • Suspected side effects to medicines used in coronavirus treatment should be reported via the Yellow Card COVID-19 reporting site


CTAG acts as a formal advisory group to the Royal College of Physicians and this position statement is endorsed by:

The CTAG Immunomodulators subgroup takes its membership from HLH Across Specialities Collaboration (HASC), a group already formed for management and research of HLH and have expanded remit to include hyper-inflammation associated with COVID-19.


Date publishedVersionAmendment
22 April 20201.0 Download PDFNew document
07 May 20201.1 Download PDFUpdated evidence summaries in Appendix 1
01 June 20202.0 Download PDFUpdated tables of trials and evidence summaries to include new proposed investigational products
16 June 20202.1Download PDFUpdated Table 1, Table 2 and Appendix 1 in line with new available trials, investigational medicines and confirmation where access to remdesivir EAMS is permitted prior to or during trial. Added mechanism of action to Table A1