Abstract

Most viral infections have limited treatment options available and the same holds for COVID-19, its causative agent being the SARS-CoV-2 virus. Drugs used in the past against Severe Acute Respiratory Syndrome (SARS) or Middle East Respiratory Syndrome (MERS) viruses, which belong to the same family of viruses as the novel Coronavirus included ribavirin, interferon (alfa and beta), lopinavir-ritonavir combination, and corticosteroids. There remains controversy regarding their efficacy to date, except for the last one. Hence, large-scale multicentric trials are being conducted involving multiple drugs. Chloroquine and hydroxy-chloroquine were initially taking the race ahead but have now been rejected. Remdesivir was a promising candidate, for which the FDA had issued an emergency use authorization, but now is not recommended by the WHO. Convalescent plasma therapy had promising results in the early severe viremia phase, but the PLACID trial made an obscure end. Only corticosteroids have shown demonstrable benefits in improving mortality rates among severe COVID-19 cases. Many new modalities like monoclonal antibodies and tyrosine kinase inhibitors are discussed. In this chapter, we review the therapeutic drugs under investigation for the COVID-19 treatment, their mode of action, degree of effectiveness, and recommendations by different centers regarding their use in current settings.

Highlights

  • Because of the high rate of infectivity of the COVID-19 virus, the global burden associated with the disease, and its impact on the economies of different countries, efforts are being made to find a possible cure for the disease as soon as possible. [1] As with most viral infections, limited options are available for the treatment of COVID-19

  • Drugs used in the past against Severe Acute Respiratory Syndrome (SARS) or Middle East Respiratory Syndrome (MERS), which belong to the group of Beta coronaviruses, included ribavirin, interferon, lopinavir-ritonavir, and corticosteroids

  • In a study published in NEJM, HCQ alone or in combination with azithromycin had no demonstrable improvement in clinical status at 15 days compared with standard care in mild to moderate COVID-19 admissions. [24]

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Summary

Introduction

Because of the high rate of infectivity of the COVID-19 virus, the global burden associated with the disease, and its impact on the economies of different countries, efforts are being made to find a possible cure for the disease as soon as possible. [1] As with most viral infections, limited options are available for the treatment of COVID-19. [1] As with most viral infections, limited options are available for the treatment of COVID-19. Since there is no efficient therapy available for the same, given the public emergency, efforts are ongoing to find drugs helpful in COVID19 infection. RdRp: RNA dependent RNA polymerase; ARDS: Acute respiratory distress syndrome; WHO: World Health Organization; CDC: Centers for Disease Control and Prevention; FDA: Food and Drug Administration; IDSA: Infectious Disease Society of America; EUA: Emergency Use Authorization; NIH: National Institute of Health; Il-6 R: Interleukin-6 receptor; STAT: Signal transducer and activator of transcription. We hereby discuss the potential therapeutic drugs under investigation for the COVID-19 treatment, their modes of action (Figure 1), degree of effectiveness, and recommendations (Table 1) by different centers regarding their usage in the current settings

Chloroquine/hydroxychloroquine
Lopinavir/ritonavir
Azithromycin
Ivermectin
Melatonin
Remdesivir
Tocilizumab
Convalescent plasma
Favipiravir
2.10 Ribavirin
2.11 Interferons
2.12 Corticosteroids
2.13 Monoclonal antibodies
2.14 Janus kinase (JAK) inhibitors
2.15 Other miscellaneous drugs with a possible therapeutic effect
Findings
Conclusion
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