SARS -CoV-2 that causes the famous disease, COVID-19, has no FDA approved treatment yet. Researchers around the world are using drugs that have previously demonstrated efficacy against similar virus types clinically or based on their in-vitro activity. Many clinical trials are also underway to demonstrate the most efficacious drug which can be used against this disease. Let's go through them today.
1. Remdesivir
Written by Devi Bavishi
Illustration by Anagha Rao
COVID-19: Summary of drugs that are under investigation for use as potential treatment options |
1. Remdesivir
- Novel nucleotide analogue
- Originally used for SARS and MERS
- Activity against SARS-CoV-2 in-vitro and against SARS and MERS-CoV both in-vitro and in
animal studies
- Recommended dose: 200 mg as a single dose on day 1, followed by 100 mg once daily for a total duration of 5 to 10 days
- Read more about Remdesivir
- Read more about Remdesivir
2. Chloroquine/Hydroxychloroquine (HCQ)
- Increases
pH (alkalinization) of acidic intracellular vesicles that may lead to inhibition of endosome-mediated fusion, viral
entry and pH-dependent steps in viral replication.
- Originally used for malaria
- Activity against SARS-CoV-2 in-vitro
- In an open-label study of 36 patients use of HCQ (200 mg three times a day for 10 days) vs no treatment showed a higher rate of undetectable RNA in the HCQ arm (12.5 vs 70%)
- recommended dose: 200 mg 3 times daily for 10 days. Alternative dosing: 400 mg twice daily on day 1 followed by 200 mg twice daily for 4 days or 400 mg twice daily on day 1 followed by 400 mg once daily for 5 days or 600 mg twice daily on day 1 followed by 400 mg once daily for 4 days. Source: UpToDate
3. Tocilizumab
- Monoclonal antibody against IL-6
- In a retrospective observational study of 21 patients, the use of tocilizumab and standard of care lead to the resolution of fever in all patients,
decrease oxygen need in 16/21 patients, CT improvement, and discharge in 19/21pts
- Recommended dose: 400 mg single dose
4. Lopinavir-Ritonavir
- Protease inhibitor
- Originally used for HIV
- Activity against SARS-CoV-2 in-vitro and some activity against MERS-CoV in animal studies
- In a randomized, controlled trial of 199 patients, use of lopinavir-ritonavir
(400/100mg) twice daily for 14 days failed to show a statistically significant difference in outcomes
- Trial dose: 400/100mg PO q12hr for 5–14 days
Other potential therapies:
1. Azithromycin
- macrolide antibiotic
- In an open-label study of HCQ+Azithromycin vs HCQ, 57.1% of patients were virologically cured
2. Sarilumab: IL-6 receptor antagonist
3. Darunavir+cobicistat:
Protease inhibitor
4. Emtricitabine+tenofovir:
NNRTI+NRTI
5. Ruxolitinib:
licensed for use in Myelofibrosis
6. Baricitinib:
inhibitor of JAK, licensed for use in Rheumatoid arthritis
7. Sirolimus:
mTor inhibitor, licensed for use as anti-rejection post kidney transplant
8. IFN-alpha:
licensed for use in hepatitis C and B
9. IFN-beta:
licensed for use in multiple sclerosis
10. IFN-gamma:
licensed for use in Chronic Granulomatous disease
11. Baloxavir:
antiviral-endonuclease inhibitor, licensed for use in acute uncomplicated
influenza
12. Favipiravir:
antiviral-RNA polymerase inhibitor, licensed for use in Influenza
13. Umifenovir
(Arbidol): antiviral
14. Nitazoxanide:
antiviral
15. Anakinra: IL-1 receptor antagonist
16. Bevacizumab:
monoclonal antibody against VEGF
17. Brilacidin:
host defense peptide mimetic
18. Disulfiram:
blocks alcohol oxidation
19: Eculizumab:
monoclonal antibody against
20. Vitamin
C: an ongoing trial with high dose Vitamin C
21. Sofosbuvir:
Antiviral, licensed for use in hepatitis C
22. Niclosamide:
Antihelminthic
23. Nelfinavir:
Protease inhibitor
24. Galidesivir:
Nucleoside RNA polymerase inhibitor
25. XueBiJing:
Chinese Herbal medication
References:
- Erin K McCreary, PharmD, BCPS, BCIDP, Jason M Pogue, PharmD, BCPS, BCIDP, on behalf of the Society of Infectious Diseases Pharmacists, COVID-19 Treatment: A Review of Early and Emerging Options, Open Forum Infectious Diseases, ofaa105 doi: 10.1093/ofid/ofaa105
- Landscape analysis of therapeutics as 21st March 2020. (2020). Retrieved 31 March 2020, from https://www.who.int/blueprint/priority-diseases/key-action/Table_of_therapeutics_Appendix_17022020.pdf
- Gautret et al. (2020) Hydroxychloroquine and azithromycin as a treatment of COVID‐19: results of an open‐label non‐randomized clinical trial. International Journal of Antimicrobial Agents – In Press 17 March 2020 DOI:10.1016/j.ijantimicag.2020.105949.
- Cao B, Wang Y, Wen D, et al. A trial of lopinavir-ritonavir in adults hospitalized with severe COVID-19. N Engl J Med. 2020. doi:10.1056/NEJMoa2001282
- Gautret, P., Lagier, J., Parola, P., Hoang, V., Meddeb, L., & Mailhe, M. et al. (2020). Hydroxychloroquine and azithromycin as a treatment of COVID-19: results of an open-label non-randomized clinical trial. International Journal Of Antimicrobial Agents, 105949. doi: 10.1016/j.ijantimicag.2020.105949
- XU X, HAN M, LI T et al.: Effective treatment of severe COVID-19 patients with tocilizumab. ChinaXiv 2020
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