An Overview of the Approaches for the Pharmacotherapy of Pandemic Causing Coronaviruses of the 21st Century

Abstract

The 21st century has witnessed 3 major pandemics caused by coronaviruses namely, severe acute respiratory syndrome, Middle East respiratory syndrome and coronavirus disease-19. Though previously considered non-pathogenic in humans, these viruses have found a way to infect the human population. The viruses have traversed various intermediate host pools from their natural reservoirs before spilling out in humans. From severe acute respiratory syndrome in 2003 to Middle East respiratory syndrome in 2012 to coronavirus disease-19 in 2019, clinical research, safety and efficacy studies performed during each outbreak have led to new developments in the pharmacotherapeutics of human coronavirus infections. Severe acute respiratory syndrome was initially identified as a disease-causing pneumonia and hence was treated by antibiotics followed by corticosteroids for acute respiratory distress syndrome. After detecting the viral origin of the disease, the use of antivirals like ribavirin, ritonavir/lopinavir, Type I Interferons and their combinations started to gain momentum. Middle East respiratory syndrome led to repositioning of therapies employed in severe acute respiratory syndrome along with introduction of new agents like mycophenolic acid, cyclosporine and remdesivir. The emergence of novel coronavirus causing coronavirus disease-19 has led to repurposing of molecules like chloroquine, remdesivir and favipiravir for containing the virus. In addition, the effectiveness of plasma therapy and antibody treatment has been investigated through small scale observational studies.