Insight in the Current Progress in the Largest Clinical Trials for Covid-19 Drug Management (As of January 2021)

Abstract

The outbreak of the COVID-19 pandemic has generated the largest global health crisis of the 21st century, evolving into accelerating socioeconomic disruption. In spite of all rapidly and widely emerging scientific data on epidemiology, diagnosis, prevention and treatment of the COVID-19 disease, severe acute respiratory coronavirus 2 (SARS-CoV-2) is continuing to propagate in lack of definitive and specific therapeutic agents. Current therapeutic strategies are mainly focused on viral inhibition by antiviral drugs and hampering the exuberant immune response of the host by immunomodulatory drugs. In this review, we have studied the reports of the largest clinical trials intended to COVID-19 treatment published during the first year of the pandemics. In general, these results concentrate on seven therapeutic options: remdesivir, chloroguine/hydroxychloroquine, lopinavir-ritonavir combination, corticosteroids, tocilizumab, convalescent plasma and monoclonal antibodies. In line with the reviewed data, as of January 2021, most of the evidence support the use of remdesivir in hospitalized patients with moderate and severe forms of the disease and provide reliable data on the substantial beneficial effect of corticosteroids in patients requiring supplemental oxygen. Moreover, preliminary RECOVERY trial results have demonstrated the efficacy of tociluzumab in the treatment of critically ill patients. The reports presenting the outcomes of the other immune-based therapies under investigation are enthusiastically awaited.

Significance of Immune Status of SARS-CoV-2 Infected Patients in Determining the Efficacy of Therapeutic Interventions

“…Therefore, the need for a clear understanding of immunopathological factors underpinning the diverse responses observed in the infected patients is of paramount significance to identify appropriate therapeutic targets [ 21 ]. Several immunomodulatory agents are currently underpinning clinical trials at a rapid pace [ 22 ], and some of them are already being under routine use in the clinical practices in off-label use of drugs [ 23 ]. An in-depth understanding of each specific inflammatory pathway and cell-type shows promising results in choosing appropriate immunotherapeutic targets.…”

COVID-19 Tedavisinde Kullanılan İlaçlar ve Farmakokinetiği

“…The study by the ACTT-1 Study Group Members demonstrated a 31 % faster recovery (11 days with remdesivir in comparison to 15 days with placebo) and a survival advantage of 7.1% mortality with remdesivir versus 11.9 % mortality with placebo (although statistically insignificant regarding mortality). Following the preliminary findings of the remdesivir ACTT-1 Trial conducted by the American National Institute of Allergy and Infectious Diseases (NIAID) [12][13][14] , the Food and Drug Administration (FDA) in the United States of America (USA) issued an Emergency Use Authorization (EUA) licensing use of remdesivir for treatment of adults and children hospitalized with verified or suspected COVID-19 infection. This authorization was modified on August 28, 2020, expanding use of remdesivir to all hospitalized patients regardless of the severity of the clinical condition.…”