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Abstract
Background The ongoing coronavirus disease-19 (COVID-19) pandemic, caused by the novel coronavirus 2 (SARS-CoV-2) has triggered a worldwide search for medications addressing the morbidity and mortality associated with it. Various medications have been proposed and applied to control COVID-19 based on previous experiences with other viral infections. Some of these have been shown to be harmful or lack efficacy. This review discusses the medications that have been repurposed for SARS-CoV-2, experimental medications undergoing clinical trials, as well as the regional variations in COVID-19 treatments. Methods A literature search was conducted to cover the period of January 2020 to September 2020 using the keywords “medications, treatment, therapeutics, pharmacological management for COVID-19” in various combinations as search strings. PubMed, LitCOVID, Google Scholar, Science Direct, and clinicaltrials.gov were the databases utilized. Results Evidence from ongoing clinical trials has shown promise with antiviral medications such as remdesivir, as well as corticosteroids, and convalescent plasma for severe cases of COVID-19. There is still, however, some conflicting evidence on the true benefits of these treatments. Other medications such as interferons, monoclonal antibodies, immune modulators, do not have enough clinical evidence of their safety and efficacy in COVID-19 patients for their recommended use. The role of anticoagulants and pulmonary vasodilators is still being explored. The efficacy of hydroxychloroquine is yet to be demonstrated in COVID-19 patients and is currently no longer recommended. Experimental medications targeting specific viral proteases are future promising therapies. Conclusions The retinue of medications being used to treat COVID-19 is evolving and expanding as more clinical trials provide results. Several potential medication therapies are currently being investigated. While awaiting an approved safe and efficacious medication to treat this virus, a periodic review of on-going research is highly encouraged.
Highlights
In the past century, the world has gone through pandemics such as the 1918 H1N1 influenza pandemic, the 1957 H2N2, and 1968 H3N2 pandemics which have brought about advances in science and led to the development of new medications and vaccines
The RECOVERY trial (NCT04381936) arm of dexamethasone showed that the use of this medication in patients hospitalized with COVID-19 resulted in lower 28-day mortality among those who were receiving either invasive mechanical ventilation or oxygen alone but not among those receiving no respiratory support.[19]
In the REMCAP clinical trial (NCT02735707) of patients with severe COVID-19, hydrocortisone treatment resulted in a 93% probability of superiority with regard to improve odds in organ support free days within 21 days compared to 80% probability in the no hydrocortisone group.[20]
Summary
The world has gone through pandemics such as the 1918 H1N1 influenza pandemic, the 1957 H2N2, and 1968 H3N2 pandemics which have brought about advances in science and led to the development of new medications and vaccines. The world has been significantly impacted by the coronavirus-19 (COVID-19) outbreak caused by the novel coronavirus-2 (SARS-CoV-2) and the race is on to find a vaccine. The ongoing coronavirus disease-19 (COVID-19) pandemic, caused by the novel coronavirus 2 (SARS-CoV-2) has triggered a worldwide search for medications addressing the morbidity and mortality associated with it. Various medications have been proposed and applied to control COVID-19 based on previous experiences with other viral infections. Some of these have been shown to be harmful or lack efficacy. This review discusses the medications that have been repurposed for SARS-CoV-2, experimental medications undergoing clinical trials, as well as the regional variations in COVID-19 treatments
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