A narrative review of emerging therapeutics for COVID-19

Mayo Clin Proc Innov Qual Outcomes. 2020 Jul 20. doi: 10.1016/j.mayocpiqo.2020.07.004. Online ahead of print.

Abstract

The novel coronavirus SARS-CoV-2, causal agent of COVID-19, quickly spread around the world resulting in the most aggressive pandemic experienced in over 100 years. Research into targeted therapies and vaccines has been initiated on an unprecedented scale and speed but will take months and even years to come to fruition. Meanwhile, the efficacy of emerging therapeutics for use in treating COVID-19 is feverishly being investigated to identify the best available treatment options for dealing with the current wave of disease. This review provides frontline clinicians with a pragmatic summary of the current state of the rapidly evolving evidence supporting emerging candidate therapeutics for COVID-19. Two main categories of pharmaceutical therapeutics are showing promise-those with antiviral activity directly addressing infection and those that counteract the inflammatory cytokine storm induced by severe disease. Preliminary results suggest that other approaches such as convalescent plasma therapy and lung radiation therapy may have some efficacy. The current clinical evidence for potential treatments is preliminary - often small retrospective series or early results from randomized trials - and the science is evolving rapidly. Long-term results from large, well-designed randomized trials will provide definitive evidence of therapeutic effectiveness and are likely months away. The trial landscape for promising therapies is described.

Keywords: CPT, convalescent plasma therapy; CQ, chloroquine; EC50, half maximal effective concentration; HCQ, hydroxychloroquine; ICU, intensive care unit; IL6, interleukin 6; LPV/RTV, lopinavir/ritonavir; MERS, Middle East respiratory syndrome; RCT, randomized controlled trial; SARS, systemic acute respiratory syndrome; SARS-CoV-2, systemic acute respiratory syndrome coronavirus-2.

Publication types

  • Review