To the Editor:
We appreciate the interest expressed by Dr. C.A. Moura and colleagues in our editorial regarding the role of the rheumatologist during the coronavirus disease 2019 (COVID-19) pandemic1. The letter by C.A. Moura, et al emphasizes the need to understand mechanisms of disease underlying the more serious complications of COVID-19 infection, as well as to provide the best treatment possible to large numbers of seriously ill patients during a global pandemic2. Many of the treatments administered to date under crisis conditions in uncontrolled fashion have been based upon at least some mechanistic rationale as reflected in the Table 1 accompanying their letter. Well-designed randomized controlled trials (RCT) take time to design, undergo ethics board review, and enroll, and some of these are beginning to result. While the US National Institutes of Health–sponsored RCT with remdesivir has been reported to shorten the time to recovery and duration of hospitalization3, it is becoming increasingly apparent that the addition of immunomodulation will likely be required to forestall progression of respiratory failure, treat underlying vascular inflammation, and significantly affect survival1,4. Until definitive RCT can be completed, …
Address correspondence to Dr. R. Cron, Children’s of Alabama, Division of Rheumatology, 1600 7th Ave. S., CPPN, Suite G10, Birmingham, AL 35233-1711, USA. Email: rcron{at}peds.uab.edu.