Drugs for the prevention and treatment of COVID-19 and its complications: An update on what we learned in the past 2 years

Abstract

The COVID-19 Committee of the Lincei Academy has reviewed the scientific evidence supporting the efficacy and safety of existing and new drugs/biologics for the preventing and treating of COVID-19 and its complications. This position paper reports what we have learned in the field in the past 2 years. The focus was on, but not limited to, drugs and neutralizing monoclonal antibodies, anti-SARS-CoV-2 agents, anti-inflammatory and immunomodulatory drugs, complement inhibitors and anticoagulant agents. We also discuss the risks/benefit of using cell therapies on COVID-19 patients. The report summarizes the available evidence, which supports recommendations from health authorities and panels of experts regarding some drugs and biologics, and highlights drugs that are not recommended, or drugs for which there is insufficient evidence to recommend for or against their use. We also address the issue of the safety of drugs used to treat underlying concomitant conditions in COVID-19 patients. The investigators did an enormous amount of work very quickly to understand better the nature and pathophysiology of COVID-19. This expedited the development and repurposing of safe and effective therapeutic interventions, saving an impressive number of lives in the community as well as in hospitals.

Epidemiology of Respiratory Infections during the COVID-19 Pandemic

“…Several sensitive and specific point-of-care tests were developed and introduced in clinical practice [ 15 ], allowing tracing of infected people, isolation, and reduction of virus circulation. Finally, several safe and effective vaccines [ 16 , 17 ], monoclonal antibodies [ 18 , 19 ], and antivirals [ 20 , 21 ] were developed and rapidly authorized for emergency use by health authorities. Although the final effectiveness of these preparations, particularly against the most recent variants, may be lower than desired, as some of the variants escape from protection induced by vaccination and monoclonal antibodies [ 22 , 23 ], they have had a dramatic positive effect.…”

Hyperimmunplasma: Gewinnung, Verarbeitung und therapeutische Anwendungen

“…Neue Studien zeigen, dass SARS-CoV-2-Immunglobuline in humanen Immunglobulinpräparaten alle bisher untersuchten Virusvarianten neutralisieren können [72,73]. Gegenüber den bei COVID-19 Erkrankten eingesetzten monoklonalen Antikörpern [74], die nur begrenzte Wirkung auf die derzeit dominierende BA.4-Variante haben [75], haben HIG und RP den Vorteil, dass sie schnell und mit hohen Neutralisationstitern gegen neue Varianten hergestellt werden können.…”

Natural Flavonoid Derivatives Have Pan-Coronavirus Antiviral Activity

“…Despite the intense efforts to develop SARS-CoV-2 specific inhibitors [ 8 ], only two antiviral agents, authorized by FDA in December 2021, have demonstrated activity in treating mild-to-moderate COVID-19 in patients who are at high risk of severe disease, including molnupiravir, an orally available base analogue that can be incorporated into RNA instead of cytidine triphosphate or uridine triphosphate, leading to mutated RNA products [ 9 ] and Paxlovid, a co-packaged combination of nirmatrelvir and ritonavir that acts as a peptidomimetic, covalent, and reversible inhibitor of 3CLpro [ 10 ]. The antiviral activity of nirmatrelvir has been reported to not be reduced when treating the SARS-CoV-2 variants Alpha (B.1.1.7), Beta (B.1.351), Gamma (P.1), Delta (B.1.617.2), and Omicron (B.1.1.529) [ 11 ], confirming the conservation of the sequence of this enzyme among coronaviruses.…”