Contentious issues and evolving concepts in the clinical presentation and management of patients with COVID-19 infectionwith reference to use of therapeutic and other drugs used in Co-morbid diseases (Hypertension, diabetes etc)

Abstract

a b s t r a c tBackground and aims: Multiple issues in management of COVID have emerged, but confusion persists regarding rational interpretation. Aim of this brief review is to review these issues based on current literature. Methods: This is a narrative review with Pubmed and Google Scholar search till 23 March 2020. Search terms were, COVID-19, treatment of coronavirus, COVID 19 and following terms; chloroquine, hydroxychloroquine, ibuprofen, ACE-inhibitors or angiotensin receptor blockers, cardiovascular disease, diarrhoea, liver, testis and gastrointestinal disease. Results: We discuss evidence regarding role of chloroquine and hydroxychloroquine in treatment and prophylaxis, use of inhibitors of the renin angiotensin system, safety of ibuprofen, unusual clinical features like gastrointestinal symptoms and interpretation of tests for cardiac enzymes and biomarkers. Conclusions: While our conclusions on management of COVID-19 patients with co-morbidities are based on current evidence, however, data is limited and there is immediate need for fast track research.

Diabetes mellitus is associated with increased mortality and severity of disease in COVID-19 pneumonia – A systematic review, meta-analysis, and meta-regression

“…One of the possible rationale behind this finding is the use of medications, particularly ACEI or ARB in hypertensive individuals. The risks and benefits associated with ACEI/ARB use in COVID-19 patients remains controversial [44], a specific type of ARB has been shown to ameliorate lung injury in SARS-CoV infection in animal model. [45] It is unfortunate that all of the included studies did not provide report on diabetic or hypertensive medications.…”

Diabetes and COVID-19: evidence, current status and unanswered research questions

“…In this subject situation is far from clear and there are too many unknown factors, which might be operative in the interaction between ACE2, diabetes, ACE inhibitors/ARBs and lung injury. The lack of evidence for either benefit or harm has prompted European Society of Cardiology Council on Hypertension, European Society of Hypertension and American Heart Association to advise continuing with ACE inhibitors and ARBs in case a patient develops COVID-19 [35]. A clinical trial is underway to study the ARB losartan and recombinant human ACE2 in patients with COVID-19.…”

Indomethacin and resveratrol as potential treatment adjuncts for SARS‐CoV‐2/COVID‐19

“…Furthermore, some authors have reported that NSAIDS such as ibuprofen may be detrimental in patients with novel coronavirus, causing more severe infection or lead to later complications such as empyema, prolonged hospital stay or lung cavitation, as has been reported in patients with bacterial pneumonia. 13,14 However, the WHO recently did not recommend against ibuprofen use for infection with SARS-CoV-2. 15 Studies have shown ibuprofen to decrease sputum IL-6 in cystic fibrosis patients 16…”