A Scoping Review of Pharmacological Management of Postacute Sequelae of Severe Acute Respiratory Syndrome Coronavirus 2 Infection in 2021

Abstract

Background: Postacute sequelae of severe acute respiratory syndrome coronavirus 2 infection (PASC), or long-COVID, are signs and symptoms that persist after the acute phase of Coronavirus disease 2019 infection has passed. PASC is newly recognized, and research is ongoing to answer questions about pathology, symptoms, diagnosis, and optimal treatment. Areas of Uncertainty: Use of pharmacologic treatment for symptoms of PASC is currently evolving. This scoping review aims to assess medical literature for any evidence supporting or refuting use of any medications to specifically treat PASC.Data Sources: PubMed, EMBASE, Web of Science, and gray literature sources were searched for any study of medication use for PASC. Studies were included if they described medication use in patients with PASC. There were no exclusion criteria based on study type or if results were reported. Studies were divided into completed works and ongoing research.Results: Fifty-two records were included in final analysis from an initial 3524 records found, including 2 randomized controlled trials, 7 prospective, open-label or observational studies, 14 case reports or case series, 1 survey, 1 correspondence, 1 retrospective analysis, and 26 studies in progress. Seven of the 26 completed works investigate ivabradine or beta-blockers, whereas 7 investigate local or systemic corticosteroids. Three investigate multi-ingredient nutritional supplements. The other 9 completed works as well as the 26 studies in progress investigate a wide variety of other treatments including drugs in development, drugs used for other conditions, herbals, supplements, and vitamins.Conclusions: There is limited, but evolving, literature on medication treatment for PASC. Providers who opt to use pharmacologic therapy for PASC need to be vigilant in their knowledge of these evolving data.

Effect of pharmacological interventions for the treatment of people with post‐COVID‐19 condition: A rapid review

“…The authors identified the terms such as “long COVID,” “post‐COVID‐19 syndrome (PCS),” post‐acute sequelae of COVID‐19 (PACS), and “SARS‐CoV‐2 post‐viral fatigue syndrome.” The authors also recommended a need for consensus on the definition of PCC. Another scoping review on medications for PCC condition has recently been published and identified 52 relevant studies [38], investigating therapies such as ivabradine, beta‐adrenoreceptor blockers, and local and systemic corticosteroids. However, half of the identified studies were still ongoing, and the vast majority of completed studies were nonexperimental (i.e., case reports/series, observational studies), providing limited evidence on the efficacy of therapy.…”

Cardiorespiratory dysautonomia in post‐COVID‐19 condition: Manifestations, mechanisms and management

“…The immunomodulating therapy has been long in focus based on the inflammatory and autoimmune hypotheses in post-COVID-19 condition [36,78]. Although there is evidence of a beneficial effect of corticosteroids on symptoms and recovery during the acute phase in hospitalized patients [79][80][81], and specifically in patients with concomitant asthma [82][83][84], similar data on pharmacological treatment options for patients with post-COVID-19 condition is scarce [84]. The selection of an appropriate therapeutic approach to possible inflammatory and autoimmune disorders underlying post-COVID-19 condition is hampered by the fact that positive laboratory findings are unspecific or very limited.…”

Therapeutic Approaches to the Neurologic Manifestations of COVID-19

“…If the diagnosis is unclear, patients with symptoms of tachycardia, orthostasis, and blood pressure fluctuations should undergo autonomic testing such as tilt-table test, where available. Patients with confirmed POTS may benefit from a beta-blocker such as propranolol or ivabradine, a heart failure drug which can lower heart rate without reducing blood pressure [190]. Patients with orthostasis should maintain proper hydration, use compression stockings, abdominal binders, and participate in graded exercise programs on their back [191].…”

“…There are 26 ongoing studies for post-Covid syndromes [190]. However, due to the limited knowledge and lack of completed, successful studies for treatment in neuro-PASC, many doctors and patients have sought alternative routes for treatment.…”