Potential specific therapies in COVID-19

Abstract

COVID-19 has grown into a global pandemic that has strained healthcare throughout the world. There is a sense of urgency in finding a cure for this deadly virus. In this study, we reviewed the empiric options used in common practice for COVID-19, based on the literature available online, with an emphasis on human experiences with these treatments on severe acute respiratory syndrome-associated coronavirus (SARS-COV-1) and other viruses. Convalescent blood products are the most promising potential treatment for use in COVID-19. The use of chloroquine or hydroxychloroquine (HCQ), remdesivir, and tocilizumab are some of the other promising potential therapies; however, they are yet to be tested in randomized clinical trials (RCTs). The use of lopinavir-ritonavir did not prove beneficial in a large RCT. The use of corticosteroids should be avoided in COVID-19 pneumonia unless used for other indications, based on the suggestion of harm in patients with SARS-COV-1 and Middle Eastern Respiratory Syndrome (MERS) infection. The reviews of this paper are available via the supplemental material section.

Treatment for COVID-19: An overview

“…The main drugs used in the context of the national emergency management plan for COVID-19 include lopinavir/ritonavir, which is mainly used in COVID-19 patients with less severe symptoms and in the early stages of the disease, managed both at home and in the hospital. Previous experiences with SARS-CoV-1 and MERS infections suggest that this drug may improve some patients’ clinical parameters ( Gul et al, 2020 ). A randomised, controlled, open-label study on oral lopinavir-ritonavir for severe COVID-19 involved 199 hospitalised adult patients infected by SARS-CoV-2 ( Cao et al, 2020 ).…”

“… Double-blind, randomised, placebo-controlled trial Hospitalised adult SARS-CoV-2 infected patients and ≤94% SaO 2 1063 patients February 21, 2020–April 19, 2020 Patients randomly assigned to receive either Remdesivir (200 mg on day 1, and 100 mg daily for up to 9 additional days) or placebo for up to 10 days A 10-day course of Remdesivir was superior to placebo in number of days to recovery (median, 11 vs 15 days; recovery rate ratio, 1.32 [95% CI, 1.12 to 1.55]) and in recovery according to ordinal scale score at day 15 (OR, 1.50; 95% CI, 1.18 to 1.91). Guaraldi, Gul et al, 2020 . Retrospective, observational cohort study Adults (≥18 years) with severe COVID-19 pneumonia, admitted to tertiary care centres 1351 patients February 21, 2020–April 30, 2020.…”

Therapeutic potential of ivermectin as add on treatment in COVID 19: A systematic review and meta-analysis

“…CI: Confidence interval; OR: Odds ratio; GRADE Working Group grades of evidence; High quality: Further research is very unlikely to change our confidence in the estimate of effect; Moderate quality: Further research is likely to have an important impact on our confidence in the estimate of effect and may change the estimate; Low quality: Further research is very likely to have an important impact on our confidence in the estimate of effect and is likely to change the estimate; Very low quality: We are very uncertain about the estimate. 1 Bias due to confounding: 2 Due to study types, 3 Due to retrospective study, 4 Due to small number of studies' 5 due to less number of study and small sample size…”

“…Since the beginning of the outbreak in December 2019, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has become a cause of global concern (1,2). Remdesivir, favipiravir, chloroquine, hydroxychloroquine, and azithromycin are some of the drugs commonly being used for the treatment of COVID-19 infection but with variable success (3)(4)(5)(6). The current management is mostly limited to general supportive care and symptomatic treatment.…”

Time-course analysis reveals that corticosteroids resuscitate diminished CD8+ T cells in COVID-19: a retrospective cohort study

“…T cell as indicators for imbalance between inflammation and antiviral immune response [3,12], at the same time interrogating the representative coagulation Corticosteroids are common and effective medications for suppressing inflammatory activity and attenuate damage from uncontrolled inflammation, which simultaneously induce T lymphocytes apoptosis [13]. Nonetheless, there is no unanimous consensus as to whether corticosteroids should be prescribed to COVID-19 patients [14][15][16][17]. Recent evidence suggests that early short course corticosteroids is correlated with reduced rate of respiratory failure, admission to an intensive care unit and mortality [17].…”