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| ==Investigational Therapies==
| | #REDIRECT[[COVID-19#Management_by_Patient_Category]] |
| Treatment for those infected with [[SARS-CoV-2]] focuses on supportive care which includes symptomatic management, hand hygiene and social distancing. While many treatments are under investigation there is no proven efficacy of any drug for human as of April 8th 2020.<ref>Auwaerter. Johns Hopkins Antibiotic guide. Coronavirus COVID-19. April 8 2020</ref>.Medication management at this time is targeted towards those requiring inpatient admission.
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| *Symptomatic management
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| *[[Antivirals]]
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| **[[Lopinavir]]/[[Ritonavir]]
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| ***Known in the U.S as Kaletra, this HIV medication has been widely used in China to treat COVID patients.<ref>https://www.reuters.com/article/us-health-coronavirus-china-wuhan-hospit/key-china-coronavirus-hospital-says-hiv-drug-beneficial-to-patients-idUSKCN21R1LX</ref>.
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| ***An RCT with 199 confirmed COVID-19 positive patients concluded that there was no benefit to treating hospitalized patients with [[Lopinavir]]/[[Ritonavir]] versus supportive care.<ref>Cao, B., Wang, Y., Wen, D., Liu, W., Wang, J., Fan, G., ... & Li, X. (2020). A trial of lopinavir–ritonavir in adults hospitalized with severe Covid-19. New England Journal of Medicine.</ref>
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| ***<b>Dose:<b> 400/100mg BID x 10 days. <ref>https://www.massgeneral.org/assets/MGH/pdf/news/coronavirus/mass-general-COVID-19-treatment-guidance.pdf</ref>
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| **[[Remdesivir]]
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| ***Previously used to treat Ebola<ref>Auwaerter. Johns Hopkins Antibiotic guide. Coronavirus COVID-19. April 8 2020</ref> this medication inhibits viral RNA polymerase and has shown some promisinng invitro activity against [[SARS-CoV-2]].
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| ***A recent small study among 53 patients with severe symptoms from COVID-19 were given [[Remdesivir]] for compassionate use. 68% percent of patients showed some clinical improvement.<ref>Grein, J., Ohmagari, N.,...Oda, R (2020). Compassionate Use of Remdesivir for Patients with Severe COVID-19. New England Journal of Medicine.</ref>
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| ***A large NIH funded trial is currently underway to assess the efficacy of this medication <ref>https://clinicaltrials.gov/ct2/show/NCT04280705</ref>
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| ***Consider using in hospitalized patients with severe symptoms and significant Oxygen requirements
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| ***Contact Gilead directly for use: compassionateaccess@gilead.com
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| ***<b>Dose:</b> 200mg IV one time. Then 100mg IV once daily for 10 days. <ref>https://www.massgeneral.org/assets/MGH/pdf/news/coronavirus/mass-general-COVID-19-treatment-guidance.pdf</ref>
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| **[[Oseltamivir]]
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| ***Several small trials have not shown any benefit in patients with COVID-19. <ref>Wang D, Hu B, Hu C, et al. Clinical Characteristics of 138 Hospitalized Patients With 2019 Novel Coronavirus-Infected Pneumonia in Wuhan, China. JAMA. E-pub Date: aheadofprint February 2020.
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| DOI # 10.1001/jama.2020.1585 . https://www.ncbi.nlm.nih.gov/pubmed/32031570 </ref>
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| **[[Baloxavir marboxil]]
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| ***Several clinical trials are underway however there is no evidence at this time for the efficacy of [[Baloxavir marboxil]] in treating COVID-19
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| **[[Favipiravir]]
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| ***A small, open label, non-randomized trial in China has shown promising results and has not been peer reviewed.<ref>https://www.jwatch.org/na51293/2020/04/09/favipiravir-potential-antiviral-covid-19</ref>
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| ***A small prospective, open label study conducted in China has shown promise in symptom reduction for moderatly ill patients with COVID-19 and has not yet been peer reviewed <ref>https://www.medrxiv.org/content/10.1101/2020.03.17.20037432v3</ref>
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| **[[Ribavirin]]
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| ***Has been used in patients with [[MERS]] with inconclusive results.<ref>Arabi YM, et al. Ribavirin and Interferon Therapy for Critically Ill Patients With Middle East Respiratory Syndrome: A Multicenter
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| Observational Study. Clin Infect Dis. 2019 Jun 25. https://www.ncbi.nlm.nih.gov/pubmed/31925415.</ref>
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| ***Small trials in China and North America have failed to establish a therapeutic benefit of Ribavirin. <ref>Devaux CA1, Rolain JM2, Colson P2, Raoult D2. New insights on the antiviral effects of chloroquine against coronavirus: what to expect for COVID-19?. Int J Antimicrob Agents. 2020 Mar 12:105938. doi: 10.1016/j.ijantimicag.2020.105938.</ref>
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| *[[Chloroquine]]/[[Hydroxychloroquine]]
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| **Antimalarial medication perhaps the most widely used in COVID-19 patients.
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| **Limited in vitro data showing efficacy of [[Chloroquine]] against [[SARS-CoV-2]].<ref>Gao J, Tian Z, Yang X. Breakthrough: Chloroquine phosphate has shown apparent efficacy in treatment of COVID-19 associated pneumonia in clinical studies. Biosci Trends. 2020. [PMID:32074550]</ref>
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| **A systematic review of the efficacy of [[Chloroquine]] has shown promise in inhibiting replication of [[SARS-CoV-2]] in vitro. <ref>Cortegiani A1, Ingoglia G2, Ippolito M2, Giarratano A2, Einav S3.A systematic review on the efficacy and safety of chloroquine for the treatment of COVID-19.J Crit Care. 2020 Mar 10. pii: S0883-9441(20)30390-7. doi: 10.1016/j.jcrc.2020.03.005.</ref>
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| **A small French study with 20 patients showed benefit in reducing symptoms and viral carriage when combined with Azithromycin. <ref>Gautret P, Lagier JC, Parola P, et al. Hydroxychloroquine and azithromycin as a treatment of COVID-19: results of an open-label non-randomized clinical trial. Int J Antimicrob Agents. 2020:105949. [PMID: 32205204] doi:10.1016/j.ijantimicag.2020.105949 </ref>
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| **Currently part of the treatment algorithim for COVID-19 inpatients in many hospitals.<ref>https://www.massgeneral.org/assets/MGH/pdf/news/coronavirus/mass-general-COVID-19-treatment-guidance.pdf</ref>
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| ** Despite the lack of evidence, the FDA has approved hydroxychloroquine use for the treatment of COVID-19. <ref>“Emergency Use Authorization.” US Food and Drug Administration. https://www.fda.gov/emergency-preparedness-and-response/mcm-legal-regulatory-and-policy-framework/emergency-use-authorization. Accessed 3/30/2020.</ref>
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| **<b>Dose:</b> 400mg PO BID x1day. Then 400mg once daily x 5 days. <ref>https://www.massgeneral.org/assets/MGH/pdf/news/coronavirus/mass-general-COVID-19-treatment-guidance.pdf</ref>
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| *[[Azithromycin]]
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| **Macrolide antibiotic with purported anti-inflammatory effects in certain respiratory conditions such as [[COPD]].
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| **A small French study with 20 patients showed benefit in reducing symptoms and viral carriage when combined with [[Hydroxychloroquine]]. <ref>Gautret P, Lagier JC, Parola P, et al. Hydroxychloroquine and azithromycin as a treatment of COVID-19: results of an open-label non-randomized clinical trial. Int J Antimicrob Agents. 2020:105949. [PMID: 32205204] doi:10.1016/j.ijantimicag.2020.105949 </ref>
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| **Recommended if there is concern for bacterial superinfection<ref>https://www.massgeneral.org/assets/MGH/pdf/news/coronavirus/mass-general-COVID-19-treatment-guidance.pdf</ref>
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| **<b>Dose:</b> 500mg x 1 day. Then 250mg x 4 days.
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| *[[Immunomodulators]]
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| **[[Interferon]]
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| **[[Tocilizumab]]
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| *[[IVIG]]
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| *Convalescent Plasma
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| **Involves using plasma from patients who recovered from COVID-19 which possibly contain antibodies to [[SARS-CoV-2]]
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| *[[BCG Vaccine]]
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| *[[ACE Inhibitor]]
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| *[[Albuterol]]
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| *[[SARS-CoV-2]] [[Vaccine]]
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| *[[Anticoagulation]]
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| **Anticoagulation may be associated with lower mortality due to COVID-19 associated vascular thromboemboli resulting in increased dead space ventilation. <ref>Tang et al. J Thromb Haemost 2020 Mar 27. PMID: 32220112 </ref>
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| *[[Glucocorticoids]]
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| **Indicated in patients with asthma, COPD, and refractory septic shock with COVID-19.
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| **The CDC and WHO recommend against routinely using corticosteroids in the initial treatment of COVID-19 patients without ARDS. <ref> Clinical Management of Severe Acute Respiratory Infection When COVID-19 Is Suspected.” World Health Organization, World Health Organization, www.who.int/publications-detail/clinical-management-of-severe-acute-respiratory-infection-when-novel-coronavirus-(ncov)-infection-is-suspected. </ref>
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| **In patients who have confirmed COVID-19 pneumonia and developed ARDS, there is a weak recommendation for starting steroids to blunt the cytokine storm. <ref>Poston JT, Patel BK, Davis AM. Management of Critically Ill Adults With COVID-19. JAMA. Published online March 26, 2020. doi:10.1001/jama.2020.4914 </ref>
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| ***<b>Dose:</b> Methylprednisolone 1 to 2 mg/kg/day for 5 to 7 days.
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| ==Contraindicated Therapies==
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| *[[Steroids]]
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| *[[NSAIDS]]
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| ==See Also==
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| {{Special:Prefixindex/COVID-19 |hideredirects=1}}
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| ==References==
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| [[Category:COVID-19]]
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