COVID-19: Medication therapy
Investigational Therapies
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.[1].Medication management at this time is targeted towards those requiring inpatient admission.
- Symptomatic management
- Antivirals
- Lopinavir/Ritonavir
- Remdesivir
- Previously used to treat Ebola[4] this medication inhibits viral RNA polymerase and has shown some promisinng invitro activity against SARS-CoV-2.
- 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.[5]
- A large NIH funded trial is currently underway to assess the efficacy of this medication [6]
- Consider using in hospitalized patients with severe symptoms and significant Oxygen requirements
- Contact Gilead directly for use: compassionateaccess@gilead.com
- Oseltamivir
- Several small trials have not shown any benefit in patients with COVID-19. [7]
- Baloxavir marboxil
- Several clinical trials are underway however there is no evidence at this time for the efficacy of Baloxavir marboxil in treating COVID-19
- Favipiravir
- Ribavirin
- Chloroquine/Hydroxychloroquine
- Antimalarial medication perhaps the most widely used in COVID-19 patients.
- Limited in vitro data showing efficacy of Chloroquine against SARS-CoV-2.[12]
- A systematic review of the efficacy of Chloroquine has shown promise in inhibiting replication of SARS-CoV-2 in vitro. [13]
- A small French study with 20 patients showed benefit in reducing symptoms and viral carriage when combined with Azithromycin. [14]
- Currently part of the treatment algorithim for COVID-19 inpatients in many hospitals in many hospitals.[15]
- Dose:
- Azithromycin
- Immunomodulators
- IVIG
- Convalescent Plasma
- Involves using plasma from patients who recovered from COVID-19 which possibly contain antibodies to SARS-CoV-2
- BCG Vaccine
- ACE Inhibitor
- SARS-CoV-2 Vaccine
- Anticoagulation
Contraindicated Therapies
See Also
COVID-19 Pages
- COVID-19 (main)
References
- ↑ Auwaerter. Johns Hopkins Antibiotic guide. Coronavirus COVID-19. April 8 2020
- ↑ https://www.reuters.com/article/us-health-coronavirus-china-wuhan-hospit/key-china-coronavirus-hospital-says-hiv-drug-beneficial-to-patients-idUSKCN21R1LX
- ↑ 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.
- ↑ Auwaerter. Johns Hopkins Antibiotic guide. Coronavirus COVID-19. April 8 2020
- ↑ Grein, J., Ohmagari, N.,...Oda, R (2020). Compassionate Use of Remdesivir for Patients with Severe COVID-19. New England Journal of Medicine.
- ↑ https://clinicaltrials.gov/ct2/show/NCT04280705
- ↑ 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. DOI # 10.1001/jama.2020.1585 . https://www.ncbi.nlm.nih.gov/pubmed/32031570
- ↑ https://www.jwatch.org/na51293/2020/04/09/favipiravir-potential-antiviral-covid-19
- ↑ https://www.medrxiv.org/content/10.1101/2020.03.17.20037432v3
- ↑ Arabi YM, et al. Ribavirin and Interferon Therapy for Critically Ill Patients With Middle East Respiratory Syndrome: A Multicenter Observational Study. Clin Infect Dis. 2019 Jun 25. https://www.ncbi.nlm.nih.gov/pubmed/31925415.
- ↑ 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.
- ↑ 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]
- ↑ 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.
- ↑ 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
- ↑ https://www.massgeneral.org/assets/MGH/pdf/news/coronavirus/mass-general-COVID-19-treatment-guidance.pdf