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Pharmacologic Treatments for COVID-19
TAKE-HOME MESSAGE
- In this literature review, the authors included studies, reports, and articles about pharmacologic treatments for COVID-19 published through March 25, 2020. They also identified 109 active pharmacologic trials for the treatment of COVID-19 as of April 2, 2020. Included in this review is a discussion of chloroquine, hydroxychloroquine, lopinavir/ ritonavir, ribavirin, remdesivir, corticosteroids, and immunomodulatory agents.
- The authors identify many limitations, including the fact that much of the published data are from observational studies or small clinical trials, and that this review focused only on adult patients. To date, no therapies have been shown to be effective, and high-quality evidence is urgently needed.
abstract
This abstract is available on the publisher's site.
Access this abstract nowImportance
The pandemic of coronavirus disease 2019 (COVID-19) caused by the novel severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) presents an unprecedented challenge to identify effective drugs for prevention and treatment. Given the rapid pace of scientific discovery and clinical data generated by the large number of people rapidly infected by SARS-CoV-2, clinicians need accurate evidence regarding effective medical treatments for this infection.
Observations
No proven effective therapies for this virus currently exist. The rapidly expanding knowledge regarding SARS-CoV-2 virology provides a significant number of potential drug targets. The most promising therapy is remdesivir. Remdesivir has potent in vitro activity against SARS-CoV-2, but it is not US Food and Drug Administration approved and currently is being tested in ongoing randomized trials. Oseltamivir has not been shown to have efficacy, and corticosteroids are currently not recommended. Current clinical evidence does not support stopping angiotensin-converting enzyme inhibitors or angiotensin receptor blockers in patients with COVID-19.
Conclusions and Relevance
The COVID-19 pandemic represents the greatest global public health crisis of this generation and, potentially, since the pandemic influenza outbreak of 1918. The speed and volume of clinical trials launched to investigate potential therapies for COVID-19 highlight both the need and capability to produce high-quality evidence even in the middle of a pandemic. No therapies have been shown effective to date.
Additional Info
Pharmacologic Treatments for Coronavirus Disease 2019 (COVID-19): A Review
JAMA 2020 Apr 13;[EPub Ahead of Print], JM Sanders, ML Monogue, TZ Jodlowski, JB CutrellFrom MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine.
This open-access article provides an excellent review on potential pharmacologic treatments for COVID-19. While there are no proven effective treatments, a significant number of potential drug targets have been identified and are undergoing rapid evaluation.
This review provides a timely summary of the many potential therapies currently in testing for COVID-19. It provides concise and valuable information about each drug’s pharmacologic actions and the rationale for their inclusion in trials. An illustration of cellular elements helps the reader appreciate the important differences between the drugs that target the viral infection versus those that target the host’s immune response.
The article includes a comprehensive list of links to “Clinical Treatment Guidance and Other Useful Resources,” and many are worth bookmarking. Another resource that is too new to be on their list is www.medsafetyscan.org. Because many of the drugs now being tested for COVID-19 require screening for QT risk, AZCERT has just released this clinical decision support program for healthcare providers to use at no expense. The MedSafety Scan website was developed by AZCERT, the curators of the QTdrugs List at CredibleMeds.org. MedSafety Scan can help clinicians and clinical investigators identify their patients’ concomitant drugs that could prolong QT, now totaling 147, and analyzes clinical risk factors for QT prolongation to calculate a QT risk score for each patient. It offers risk stratification, major drug interaction detection, and suggests options for management. MedSafety Scan is based on scientifically validated, hospital-based decision support programs and has the flexibility of a Web-based program.