REMDESIVIR
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NUCLEOTIDE ANALOGUE Inhibits viral RNA-dependent RNA polymerase (RdRp)(1515. Phua J, Weng L, Ling L, Egi M, Lim CM, Divatia JV, et al. Intensive care management of coronavirus disease 2019 (COVID-19): challenges and recommendations. Lancet Respir Med. 2020; 8:506-17. Erratum in: Lancet Respir Med. 2020; 8:e42.). |
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Deemed to be the most promising candidate drug by experts convened in January, 2020, by WHO.
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Effectively inhibited SARS-CoV-2, MERS-CoV, and SARS-CoV in vitro (1515. Phua J, Weng L, Ling L, Egi M, Lim CM, Divatia JV, et al. Intensive care management of coronavirus disease 2019 (COVID-19): challenges and recommendations. Lancet Respir Med. 2020; 8:506-17. Erratum in: Lancet Respir Med. 2020; 8:e42.).
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LOPINAVIR/RITONAVIR
The timing of administration is during the early peak viral replication phase (initial 7-10 days). |
PROTEASE INHIBITOR
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It demonstrated in vitro activity against other novel coronaviruses via inhibition of 3-chymotrypsin-like protease (2727. Sanders JM, Monogue ML, Jodlowski TZ, Cutrell JB. Pharmacologic Treatments for Coronavirus Disease 2019 (COVID-19): A Review. JAMA. 2020. Epub ahead of print.).
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Second candidate identified for rapid implementation in clinical trials.
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A relevant study shows that it is associated with reduced viral load and mortality in an observational study of SARS-CoV (1515. Phua J, Weng L, Ling L, Egi M, Lim CM, Divatia JV, et al. Intensive care management of coronavirus disease 2019 (COVID-19): challenges and recommendations. Lancet Respir Med. 2020; 8:506-17. Erratum in: Lancet Respir Med. 2020; 8:e42.).
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HYDROXYCHLOROQUINE
+ AZITHROMYCIN
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ANTIMALARIAL
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block viral entry into cells by inhibiting glycosylation of host receptors, proteolytic processing, and endosomal acidification.
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Immunomodulatory effects through attenuation of cytokine production and inhibition of autophagy and lysosomal activity in host cells (2727. Sanders JM, Monogue ML, Jodlowski TZ, Cutrell JB. Pharmacologic Treatments for Coronavirus Disease 2019 (COVID-19): A Review. JAMA. 2020. Epub ahead of print.).
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Reduced SARS-CoV-2 load in the nasopharynx of patients with COVID-19, especially when combined with azithromycin (2828. Gautret P, Lagier JC, Parola P, Hoang VT, Meddeb L, Mailhe M, et al. Hydroxychloroquine and azithromycin as a treatment of COVID-19: results of an open-label non-randomized clinical trial. Int J Antimicrob Agents. 2020: Epub ahead of print.).
Despite these promising results, this study had several major limitations. |
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INTRAVENOUS IMMUNOGLOBULIN
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400 mg/kg once daily for 3-5 days. In the first 7 to 10 days of infection, when viremia is at its peak and the primary immune response has not yet occurred (2727. Sanders JM, Monogue ML, Jodlowski TZ, Cutrell JB. Pharmacologic Treatments for Coronavirus Disease 2019 (COVID-19): A Review. JAMA. 2020. Epub ahead of print.).
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IMMUNOTHERAPY |
A study of human polyclonal immunoglobulin G (SAB-300) in a mouse model of MERS-CoV found reduced viral lung titers near or below the detection limit in mice infected with MERS-CoV (1515. Phua J, Weng L, Ling L, Egi M, Lim CM, Divatia JV, et al. Intensive care management of coronavirus disease 2019 (COVID-19): challenges and recommendations. Lancet Respir Med. 2020; 8:506-17. Erratum in: Lancet Respir Med. 2020; 8:e42.). |
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CONVALESCENT PLASMA In the first 7 to 10 days of infection, when viremia is at its peak and the primary immune response has not yet occurred. |
IMMUNOTHERAPY |
In SARS-COV-2 is associated with reduction in viral load and improvement in fever, oxygenation, and chest imaging in a case series, but study limited by small sample size, multiple possible confounders, and absence of controls (1515. Phua J, Weng L, Ling L, Egi M, Lim CM, Divatia JV, et al. Intensive care management of coronavirus disease 2019 (COVID-19): challenges and recommendations. Lancet Respir Med. 2020; 8:506-17. Erratum in: Lancet Respir Med. 2020; 8:e42.). |
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Studies of SARS-CoV have not reported serious adverse events (1515. Phua J, Weng L, Ling L, Egi M, Lim CM, Divatia JV, et al. Intensive care management of coronavirus disease 2019 (COVID-19): challenges and recommendations. Lancet Respir Med. 2020; 8:506-17. Erratum in: Lancet Respir Med. 2020; 8:e42.).
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CORTICOSTEROID
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ANTI-INFLAMMATORY Decrease the host inflammatory responses in the lungs. |
There is a wide divergence of opinion in the literature on whether corticosteroids should be used in patients with COVID-19, but there is no justification to deny the use of CST in severe life-threatening “cytokine storm” associated with COVID-19(2929. Villar J, Confalonieri M, Pastores SM, Meduri GU. Rationale for Prolonged Corticosteroid Treatment in the Acute Respiratory Distress Syndrome Caused by Coronavirus Disease 2019. Crit Care Explor. 2020; 2:e0111.) |
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TOCILIZUMAB
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monoclonal antibody against interleukin-6 |
Licensed for cytokine release syndrome; hypothetically work against cytokine storm with raised ferritin and interleukin-6 levels due to SARS-CoV-2 (1515. Phua J, Weng L, Ling L, Egi M, Lim CM, Divatia JV, et al. Intensive care management of coronavirus disease 2019 (COVID-19): challenges and recommendations. Lancet Respir Med. 2020; 8:506-17. Erratum in: Lancet Respir Med. 2020; 8:e42.). |
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Increase in upper respiratory tract infections (including tuberculosis) and other infections, hypertension, infusion related reactions, hematologic effects, hepatotoxicity, gastrointestinal perforations.
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