Treatment Considerations for COVID-19

Abstract

The novel severe acute respiratory syndrome coronavirus 2 is causing a worldwide pandemic that may lead to a highly morbid and potentially fatal coronavirus disease 2019 (COVID-19). There is currently no drug that has been proven as an effective therapy for COVID-19. Several candidate drugs are being considered and evaluated for treatment. This includes clinically available drugs, such as chloroquine, hydroxychloroquine, and lopinavir/ritonavir, which are being repurposed for the treatment of COVID-19. Novel experimental therapies, such as remdesivir and favipiravir, are also actively being investigated for antiviral efficacy. Clinically available and investigational immunomodulators, such as the interleukin 6 inhibitors tocilizumab and sarilumab and the antiegranulocyte-macrophage colonystimulating factor lenzilumab, are being tested for their anticipated effect in counteracting the proinflammatory cytokine environment that characterizes severe and critical COVID-19. This review article examines the evidence behind the potential use of these leading drug candidates for the treatment of COVID-19. The authors conclude, based on this review, that there is still no high-quality evidence to support any of these proposed drug therapies. The authors, therefore, encourage the enrollment of eligible patients to multiple ongoing clinical trials that assess the efficacy and safety of these candidate therapies. Until the results of controlled trials are available, none of the suggested therapeutics is clinically proven as an effective therapy for COVID-19.

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“…Several classes of drugs are being evaluated for the management of COVID-19: antivirals, antibodies, anti-inflammatory agents, targeted immunomodulatory therapies, anticoagulants, and antifibrotics. However, no proven drug for the treatment of COVID-19 is currently available [48]. Our inhibitors capable of both inhibiting viral infection and modulating immune responses may synergize to block the disease at multiple stages over its natural history.…”

Potential Therapeutic Options for COVID-19: Current Status, Challenges, and Future Perspectives

“…The antimalarial drugs (e.g., hydroxychloroquine, chloroquine, quinacrine) are considered for a long time as effective therapies against malaria, and are also believed to have selective antiinflammatory effects against chronic inflammatory diseases (e.g., systemic lupus erythematosus, rheumatoid arthritis), have antiviral effects against different types of RNA viruses (e.g., dengue, chikungunya, HIV, SARS-CoVs, MERS-CoV), and also have immunomodulatory effects by inhibiting autophagy and lysosomal activity in host cells via cytokine signaling (Canadian Hydroxychloroquine Study Group, 1991;Rogoveanu et al, 2018;Vijayvargiya et al, 2020). A randomized and placebo-controlled phase 3 clinical study (NCT04308668) is being recruited for the treatment of COVID-19 patients (n = 3000) to evaluate the effectiveness of postexposure prophylaxis and preemptive therapy with hydroxychloroquine (200 mg tablet; 800 mg once, followed in 6 to 8 h by 600 mg, then 600 mg once daily for 4 days) (Clinicaltrials.Gov, 2020bb).…”

Pharmacological treatments of COVID-19

“…The rapid fall of nasopharyngeal viral load in COVID-19 patients has been reported after they received HCQ and azithromycin combination therapy [ 142 – 144 ].…”