Treatment options for COVID-19: The reality and challenges

J Microbiol Immunol Infect. 2020 Jun;53(3):436-443. doi: 10.1016/j.jmii.2020.03.034. Epub 2020 Apr 4.

Abstract

An outbreak related to the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) was first reported in Wuhan, China in December 2019. An extremely high potential for dissemination resulted in the global coronavirus disease 2019 (COVID-19) pandemic in 2020. Despite the worsening trends of COVID-19, no drugs are validated to have significant efficacy in clinical treatment of COVID-19 patients in large-scale studies. Remdesivir is considered the most promising antiviral agent; it works by inhibiting the activity of RNA-dependent RNA polymerase (RdRp). A large-scale study investigating the clinical efficacy of remdesivir (200 mg on day 1, followed by 100 mg once daily) is on-going. The other excellent anti-influenza RdRp inhibitor favipiravir is also being clinically evaluated for its efficacy in COVID-19 patients. The protease inhibitor lopinavir/ritonavir (LPV/RTV) alone is not shown to provide better antiviral efficacy than standard care. However, the regimen of LPV/RTV plus ribavirin was shown to be effective against SARS-CoV in vitro. Another promising alternative is hydroxychloroquine (200 mg thrice daily) plus azithromycin (500 mg on day 1, followed by 250 mg once daily on day 2-5), which showed excellent clinical efficacy on Chinese COVID-19 patients and anti-SARS-CoV-2 potency in vitro. The roles of teicoplanin (which inhibits the viral genome exposure in cytoplasm) and monoclonal and polyclonal antibodies in the treatment of SARS-CoV-2 are under investigation. Avoiding the prescription of non-steroidal anti-inflammatory drugs, angiotensin converting enzyme inhibitors, or angiotensin II type I receptor blockers is advised for COVID-19 patients.

Keywords: Angiotensin converting enzyme inhibitors; Coronavirus disease 2019 (COVID-19); Hydroxychloroquine; Non-steroidal anti-inflammatory drugs; Remdesivir; Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2).

Publication types

  • Review

MeSH terms

  • Adenosine Monophosphate / analogs & derivatives
  • Adenosine Monophosphate / therapeutic use
  • Alanine / analogs & derivatives
  • Alanine / therapeutic use
  • Amides / therapeutic use
  • Antiviral Agents / therapeutic use*
  • Azithromycin / therapeutic use
  • Betacoronavirus / drug effects*
  • COVID-19
  • Coronavirus Infections / drug therapy*
  • Coronavirus Infections / therapy
  • Drug Combinations
  • Humans
  • Hydroxychloroquine / therapeutic use
  • Immunization, Passive / methods
  • Lopinavir / therapeutic use
  • Pandemics
  • Pneumonia, Viral / drug therapy*
  • Pyrazines / therapeutic use
  • RNA-Dependent RNA Polymerase / antagonists & inhibitors
  • Ritonavir / therapeutic use
  • SARS-CoV-2
  • Teicoplanin / therapeutic use

Substances

  • Amides
  • Antiviral Agents
  • Drug Combinations
  • Pyrazines
  • lopinavir-ritonavir drug combination
  • Lopinavir
  • remdesivir
  • Adenosine Monophosphate
  • Hydroxychloroquine
  • Teicoplanin
  • Azithromycin
  • RNA-Dependent RNA Polymerase
  • favipiravir
  • Ritonavir
  • Alanine

Supplementary concepts

  • COVID-19 serotherapy