The COVID-19 pandemic has led to a massive response among researchers to identify effective pharmacologic treatments for preventing and treating infection with the novel coronavirus (severe acute respiratory syndrome coronavirus 2, SARS-CoV-2).
In a paper published online in JAMA on April 13, 2020, researchers from the University of Texas Southwestern Medical Center and the Veterans Administration North Texas Health Care System, Dallas, TX, USA, provided an overview of therapies that are currently under investigation or being considered as interventions for COVID-19. In their conclusion, the authors state that no therapies have been shown effective to date, but they cite the speed and number of clinical trials initiated to identify useful therapies as capability for generating high-quality evidence.
The information in the article is derived from findings of a literature review of English language articles published through March 25, 2020 along with clinical trials registered on clinicaltrials.gov and in the Chinese Clinical Trial Registry. On April 2, 2020 when the manuscript was being written, there were 291 active clinical trials specific to COVID-19. Of those studies, 109 were investigating pharmacological therapies; 29 were placebo-controlled studies.
Many of the drugs being considered as treatment for COVID-19 are already commercially available. They include chloroquine/hydroxychloroquine, several antiviral drugs (lopinavir, ritonavir, ribavirin, oseltamivir, umifenovir), interferon-α and interferon-β, nitazoxanide and camostat mesylate. Some of these drugs have been previously used to treat other coronavirus infections (severe acute respiratory syndrome and Middle East respiratory syndrome), and a few have demonstrated in vitro activity against SARS-CoV-2.
The investigational antiviral agent remdesivir is described as “the most promising therapy”. Remdesivir has potent in vitro activity against SARS-CoV-2, was found to be well-tolerated in a phase I clinical trial, appeared useful in case reports of patients with COVID-19 and is being investigated in randomised controlled clinical trials enrolling patients with moderate or severe COVID-19. Other than to patients who are participating in a clinical trial, remdesivir is available on a compassionate use basis for paediatric patients and pregnant women or through application for emergency access through an expanded use program.
The article in JAMA also lists links to online resources with information relevant to the treatment of patients with COVID-19, and the authors provide answers to eight frequently asked questions. Included within the latter, they cite recommendations for continuing existing treatment with angiotensin-converting enzyme inhibitors or angiotensin receptor blockers and avoiding corticosteroids unless their use is indicated because of a concomitant indication (eg chronic obstructive pulmonary disease exacerbation or pressor-refractory shock).
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