SARS-CoV-2 pharmacologic therapies and their safety/effectiveness according to level of evidence

Am J Emerg Med. 2020 Nov;38(11):2405-2415. doi: 10.1016/j.ajem.2020.08.091. Epub 2020 Sep 1.

Abstract

Introduction: There is a pressing need for COVID-19 transmission control and effective treatments. We aim to evaluate the safety and effectiveness of SARS-CoV-2 pharmacologic therapies as of August 2, 2020 according to study level of evidence.

Methods: PubMed, ScienceDirect, Cochrane Library, JAMA Network and PNAS were searched. The following keywords were used: ((COVID-19) OR (SARS-CoV-2)) AND ((((((therapeutics) OR (treatment)) OR (vaccine)) OR (hydroxychloroquine)) OR (antiviral)) OR (prognosis)). Results included peer-reviewed studies published in English.

Results: 15 peer-reviewed articles met study inclusion criteria, of which 14 were RCTs and one was a systematic review with meta-analysis. The following pharmacologic therapies were evaluated: chloroquine (CQ), hydroxychloroquine (HCQ), antivirals therapies, plasma therapy, anti-inflammatories, and a vaccine.

Conclusion: According to level 1 evidence reviewed here, the most effective SARS-Co-V-2 pharmacologic treatments include remdesivir for mild to severe disease, and a triple regimen therapy consisting of lopinavir-ritonavir, ribavirin and interferon beta-1b for mild to moderate disease. Also, dexamethasone significantly reduced mortality in those requiring respiratory support. However, there is still a great need for detailed level 1 evidence on pharmacologic therapies.

Keywords: COVID-19 clinical outcomes; COVID-19 pharmacologic treatments; Drug effectiveness; Drug safety; SARS-CoV-2.

Publication types

  • Review

MeSH terms

  • Adenosine Monophosphate / analogs & derivatives
  • Adenosine Monophosphate / therapeutic use
  • Alanine / analogs & derivatives
  • Alanine / therapeutic use
  • Antiviral Agents / therapeutic use
  • COVID-19 / drug therapy*
  • COVID-19 / prevention & control*
  • Chloroquine / therapeutic use
  • Dexamethasone / therapeutic use
  • Drug Combinations
  • Evidence-Based Medicine
  • Humans
  • Hydroxychloroquine / therapeutic use
  • Interferon beta-1b / therapeutic use
  • Lopinavir / therapeutic use
  • Meta-Analysis as Topic
  • Randomized Controlled Trials as Topic
  • Ribavirin / therapeutic use
  • Ritonavir / therapeutic use
  • Systematic Reviews as Topic

Substances

  • Antiviral Agents
  • Drug Combinations
  • lopinavir-ritonavir drug combination
  • Interferon beta-1b
  • Lopinavir
  • remdesivir
  • Adenosine Monophosphate
  • Ribavirin
  • Hydroxychloroquine
  • Dexamethasone
  • Chloroquine
  • Ritonavir
  • Alanine