Therapeutic Strategies for COVID-19 Lung Disease in Children

Abstract

The novel Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) infection has milder presentation in children than in adults, mostly requiring only supportive therapy. The immunopathogenic course of COVID-19 can be divided in two distinct but overlapping phases: the first triggered by the virus itself and the second one by the host immune response (cytokine storm). Respiratory failure or systemic involvement as Multisystem Inflammatory Syndrome in Children (MIS-C) requiring intensive care are described only in a small portion of infected children. Less severe lung injury in children could be explained by qualitative and quantitative differences in age-related immune response. Evidence on the best therapeutic approach for COVID-19 lung disease in children is lacking. Currently, the approach is mainly conservative and based on supportive therapy. However, in hospitalized children with critical illness and worsening lung function, antiviral therapy with remdesivir and immunomodulant treatment could be considered the “therapeutic pillars.”

Evaluation of the safety profile and therapeutic efficacy of remdesivir in children with SARS-CoV-2 infection – a single-center, retrospective, cohort study

“…International efforts have been launched to develop both a safe and effective vaccine and appropriate therapeutic strategies [ 2 ]. Progress in understanding the pathogenesis of SARS-CoV-2 infection has led to the introduction of several therapeutic options, particularly in the adult population, who are at higher risk of developing severe pneumonia and other complications, including death [ 2 , 3 ]. Remdesivir was the first such drug to be approved in Europe (July 3, 2020) [ 4 ].…”

“…It was developed in 2013 during work on a drug against hepatitis C virus (HCV), and then its effectiveness against viruses such as respiratory syncytial virus (RSV), severe acute respiratory syndrome coronavirus (SARS-CoV) and Middle East respiratory syndrome coronavirus (MERS-CoV) was observed [ 6 ]. It was developed in 2017 for the treatment of Ebola virus infection, where it did not achieve therapeutic efficacy, but its safety profile allowed the initiation of drug repurposing research, including SARS-CoV-2 [ 3 , 5 ].…”

Evaluation of the safety profile and therapeutic efficacy of remdesivir in children with SARS- CoV-2 infection – a single-centre, retrospective, cohort study

“…Trials of international concern have begun on both the development of a safe and effective vaccine and appropriate therapeutic strategies [2]. The research progress concerning the pathogenesis of SARS-CoV-2 infection has contributed to implementation of various therapeutic methods, especially in the adult population being at higher risk of developing severe pneumonia and other complications, including death [2,3]. Remdesivir was the rst such drug approved in Europe (July 3, 2020) [4].…”

“…It was created during works on drug against hepatitis C virus (HCV) in 2013, and then its effectiveness in the ght against viruses such as respiratory syncytial virus (RSV), severe acute respiratory syndrome coronavirus (SARS-CoV) and Middle East respiratory syndrome coronavirus (MERS-CoV) was observed [6]. It was developed in 2017 to treat Ebola virus infection, in which it did not achieve therapeutic effectiveness, but its safety pro le allowed the start of drug repurposing research, including SARS-CoV-2 [3,5].…”

“…To date, only a few clinical practice guidelines have been developed for children with COVID-19. The reason for this, among others, is signi cantly limited number of paediatric clinical trials on drugs used to treat COVID-19 [3,12]. Remdesivir was not only the rst drug approved for the treatment of COVID-19, but also the rst and most widely used in children.…”