Anti-viral treatment for SARS-CoV-2 infection: A race against time amidst the ongoing pandemic

Natalia G Vallianou; Dimitrios Tsilingiris; Gerasimos Socrates Christodoulatos; Irene Karampela; Maria Dalamaga

doi:10.1016/j.metop.2021.100096

Anti-viral treatment for SARS-CoV-2 infection: A race against time amidst the ongoing pandemic

Metabol Open. 2021 Jun:10:100096. doi: 10.1016/j.metop.2021.100096. Epub 2021 May 25.

Authors

Natalia G Vallianou¹, Dimitrios Tsilingiris², Gerasimos Socrates Christodoulatos³, Irene Karampela⁴, Maria Dalamaga³

Affiliations

¹ First Department of Internal Medicine, Evangelismos General Hospital, 45-47 Ipsilantou str, 10676, Athens, Greece.
² First Department of Propaedeutic Internal Medicine, School of Medicine, National and Kapodistrian University of Athens, Laiko General Hospital, 17 St Thomas street, 11527, Athens, Greece.
³ Department of Biological Chemistry, School of Medicine, National and Kapodistrian University of Athens, 75 Mikras Asias, 11527, Athens, Greece.
⁴ Second Department of Critical Care, Attikon General University Hospital, Medical School, National and Kapodistrian University of Athens, 1 Rimini St, Haidari, 12462, Athens, Greece.

Abstract

Remdesivir (GS-5734), a drug initially developed to treat hepatitis C and Ebola virus disease, was the first approved treatment for severe coronavirus disease 2019 (COVID-19). However, apart from remdesivir, there is a paucity of other specific anti-viral agents against SARS-CoV-2 infection. In 2017, researchers had documented the anti-coronavirus potential of remdesivir in animal models. At the same time, trials performed during two Ebola outbreaks in Africa showed that the drug was safe. Although vaccines against SARS-CoV-2 infection have emerged at an enormously high speed, equivalent results from efforts towards the development of anti-viral drugs, which could have played a truly life-saving role in the current stage of the pandemic, have been stagnating. In this review, we will focus on the current treatment options for COVID-19 which mainly consist of repurposed agents or treatments conferring passive immunity (convalescent plasma or monoclonal antibodies). Additionally, potential specific anti-viral therapies under development will be reviewed, such as the decoy miniprotein CTC-445.2d, protease inhibitors, mainly against the Main protein Mpro, nucleoside analogs, such as molnupiravir and compounds blocking the replication transcription complex proteins, such as zotatifin and plitidepsin. These anti-viral agents seem to be very promising but still require meticulous clinical trial testing in order to establish their efficacy and safety. The continuous emergence of viral variants may pose a real challenge to the scientific community towards that end. In this context, the advent of nanobodies together with the potential administration of a combination of anti-viral drugs could serve as useful tools in the armamentarium against COVID-19.

Keywords: Antiviral treatment; Baricitinib; COVID-19; Favipiravir; Molnupiravir; Monoclonal antibodies; Nanobodies; Plitidepsin; Protease inhibitors; Ribavirin; SARS-CoV-2; Zotatifin; boceprevir.