COVID-19 has been announced pandemic by WHO and over 17,000,000 people infected (Till April 21st 2020). The disease is currently under control in China, with a curative rate of 86.8%. Chloroquine (CQ) is an old anti-malarial drug with good tolerability, which had proved to be effective in previous SARS-coronavirus, which spread and disappeared between 2002-2003. In vitro studies demonstrated the efficacy of CQ in curing COVID-19. Consequently, via analytical PBPK modeling, a further preliminary clinical trial has proved the efficacy and safety of CQ in China., and multiple clinical trials were registered and approved to investigate the activity of other analogs of CQ against COVID-19. We have listed all the clinical trials and made a meta-analysis of published data of hydroxychloroquine (HCQ). HCQ could increase the CT improvement and adverse reactions (ADRs) significantly though there was considerable heterogeneity among current researches. Actually, CQ and its analogs have unique pharmacokinetic characteristics, which would induce severe side effects in some circumstances. We have then summarized pharmacological considerations for these drugs so as to provide to the busy clinicians to avoid potential side effects when administered CQ or its analogs to COVID-19 patients, especially in the elderly, pediatrics, and pregnancies.
Since December 2019 to May 2020, coronavirus disease 2019 (COVID-19) has infected over 6 million people worldwide. Due to its sudden and rapid outbreak, effective treatment for COVID-19 is scarce. Based on national clinical trials of novel treatments, China, Italy, Germany, and other countries and organizations have published multiple guidelines for COVID-19 and advised many medicines, such as chloroquine and tocilizumab. In this paper, we summarize the pharmacotherapy for COVID-19 according to those guidelines, highlight updates of the pharmacotherapy guidelines, and review the efficacy and safety of the indicated anti-COVID-19 drugs.
Objective: To compare the efficacy and safety of antiviral agents currently studied for the treatment of the COVID-19 pandemic. Methods: A literature search was conducted on the PubMed, EMBASE, Web of Science, CNKI (Chinese Database), and MedRxiv for studies published from 1966 till May 10, 2020, and identified articles containing "COVID-19" and "antiviral agents". Studies were reviewed and screened in the guidance of PRISMA. STATA 15.1 software was used to build a random-effects model. Heterogeneity was assessed using I 2. The Cochrane Risk of Bias or Newcastle-Ottawa-Scale (NOS) was employed to evaluate the public bias. Results: We identified 916 papers and included 7 studies involving 878 patients. The network meta-analysis was centered on comparing the efficacy and safety of presently used antiviral drugs for COVID-19. Among the antiviral agents applied in the treatment of COVID-19 treatment, including lopinavir/ritonavir, remdesivir, favipiravir, arbidol (umefenovir) or placebo, favipiravir exhibited significantly better efficacy in nucleic acid conversion rate [RR 2.38, 95%CI (1.05, 5.41)] and CT improvements [RR 1.85, 95%CI (1.07, 3.2)] than arbidol as well as other included antivirals though no significant association were found. ARB had advantages in nucleic acid conversion rate and ADRs incidence. Besides, favipiravir was more superior in safety than other antiviral drugs assessed by SUCRA (Surface Under the Cumulative Ranking Curve) ranking. Conclusions: Favipiravir had better efficacy in clinical recovery as well as more acceptable safety, though further clinical research should be designed to confirm these results. With the limited data of remdesivir, we could not conclude a statistical advantages of using remdesivir.
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