Recent Antiviral Treatment and Vaccination Strategies Against SARS-CoV-2

Abstract

Since the end of 2019, the novel severe acute respiratory syndrome coronavirus type 2 (SARS-CoV-2) has been spreading worldwide and has caused severe health and economic issues on a global scale. By the end of February 2021, more than 100 million SARS-CoV-2 cases had been reported worldwide. SARS-CoV-2 causes the coronavirus disease 2019 (COVID-19) that can be divided into three phases: An early phase with fever and cough (phase I), a pulmonary vascular disease (phase II) and a hyperinflammatory syndrome (phase III). Since viral replication plays a particularly important role in the early stage of the disease and the patientʼs immune system in the later course of infection, different therapeutic options arise depending on the stage of the disease. The antiviral nucleoside analogue remdesivir is the only antiviral compound with conditional approval in the European Union. Treatment with remdesivir should be initiated early (within the first seven days of symptom onset) in patients receiving supplemental oxygen without invasive ventilation. In turn, the anti-inflammatory corticosteroid dexamethasone should be administered later in the course of disease in patients receiving oxygen therapy. Since autopsies indicate an increased frequency of thromboembolic events due to COVID-19, additional treatment with anticoagulants is recommended. Since the development of novel antivirals may take years, the application of convalescent plasma from patients who recovered from a SARS-CoV-2 infection for the treatment of COVID-19 is reasonable. However, large-scale studies indicated low efficacy of convalescent plasma. Furthermore, vaccination of the population is essential to control the pandemic. Currently, the mRNA vaccine Tozinameran from BioNTech and Pfizer, the mRNA-1273 vaccine from Moderna as well as the vector vaccine AZD1222 from AstraZeneca are licensed in the European Union. All three vaccines have demonstrated high efficacy in large clinical trials. In addition to these licensed vaccines, many others are being tested in clinical trials. In the present article, an overview of therapeutic options for COVID-19 as well as vaccines for protection against SARS-CoV-2 is provided.

Bilaterale akute makuläre Neuroretinopathie (AMN) nach COVID-19 und Verlauf

“…Der Eintritt des umhüllten, einzelsträngigen RNA-Virus SARS-Cov-2 hängt hauptsächlich ab von der Bindung des Spike-Proteins (S-Protein) an spezifische Transmembranrezeptoren, wie das Angiotensin-konvertierende-Enzym 2 (ACE-2), und an transmembrane Serinproteasen, wie TMPRSS2 5 , 6 , 7 . Beide Bindungsstellen werden auf Netzhautzellen exprimiert und machen damit eine Beteiligung des retinalen Gefäßsystems und der Netzhautschichten durch eine viral induzierte endotheliale Dysfunktion möglich 8 , 9 , 10 .…”

Early Treatment with Monoclonal Antibodies or Convalescent Plasma Reduces Mortality in Non-Vaccinated COVID-19 High-Risk Patients

“…Immunotherapy of potentially lethal infections, lacking specific preventive and therapeutic options, with passive immunization with convalescent plasma was successfully used in other viral diseases such as SARS, Ebola or influenza A (H5N1) [ 6 , 7 , 8 , 9 ]. The experimental treatment of SARS-CoV-2 infection with convalescent plasma has therefore been proposed particularly in the vulnerable cohort of high-risk patients [ 10 , 11 , 12 , 13 , 14 , 15 ]. Initial studies reported an improvement in the clinical condition and survival in patients undergoing plasma treatment [ 16 , 17 , 18 , 19 ].…”

“…Within the progress of the pandemic, major advances have been achieved in understanding, prevention, and treatment of the disease. COVID-19 can be subdivided in three different phases: An early phase with viremia, fever and cough (phase I), a pulmonary vascular disease (phase II) and a hyperinflammatory syndrome (phase III) [ 13 ]. Notably, the viral replication plays an important role in the early stage of infection.…”

“…Obviously, the onset of passive antibody treatment must occur in a timely manner after infection to be effective [ 24 ]. Consequently, antiviral interventions are most effective during the early phase of the disease, whereas immunoregulatory treatment occurs effective during the hyperinflammatory stage [ 13 ]. The direct antiviral drugs remdesivir, molnupinavir and nirmatrelvir/ritonavir have been shown to be effective for preventing severe forms of COVID-19 if administered early [ 25 ].…”

A survey on the safety of the SARS-CoV-2 vaccine among a population with stroke risk in China

“…In the current lack of specific drugs, vaccination is an effective way to control the COVID-19 pandemic (8). However, sporadic adverse events in the cardiovascular system (9,10) were reported to occur after SARS-CoV-2 vaccination, such as immune thrombotic thrombocytopenia (11), idiopathic thrombocytopenic purpura, arterial thromboembolic events (such as ischemic stroke), hemorrhagic events (such as hemorrhagic stroke), and cerebral venous sinus thrombosis (12)(13)(14)(15).…”