Treatment options for COVID-19: The reality and challenges

• Published in: Journal of microbiology, immunology and infection Vol. 53; no. 3; pp. 436 - 443
• Main Authors: Jean, Shio-Shin, Lee, Ping-Ing, Hsueh, Po-Ren
• Format: Journal Article
• Language: English
• Published: England Elsevier B.V 01.06.2020; Taiwan Society of Microbiology. Published by Elsevier Taiwan LLC; Elsevier
• Subjects: Adenosine Monophosphate - analogs & derivatives; Adenosine Monophosphate - therapeutic use; Alanine - analogs & derivatives; Alanine - therapeutic use; Amides - therapeutic use; Angiotensin converting enzyme inhibitors; Antiviral Agents - therapeutic use; Azithromycin - therapeutic use; Betacoronavirus - drug effects; Coronavirus disease 2019 (COVID-19); Coronavirus Infections - drug therapy; Coronavirus Infections - therapy; COVID-19; COVID-19 Serotherapy; Drug Combinations; Humans; Hydroxychloroquine; Hydroxychloroquine - therapeutic use; Immunization, Passive - methods; Lopinavir - therapeutic use; Non-steroidal anti-inflammatory drugs; Pandemics; Pneumonia, Viral - drug therapy; Pyrazines - therapeutic use; Remdesivir; Ritonavir - therapeutic use; RNA-Dependent RNA Polymerase - antagonists & inhibitors; SARS-CoV-2; Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2); Teicoplanin - therapeutic use; Remdesivir; Hydroxychloroquine; Angiotensin converting enzyme inhibitors; Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2); Coronavirus disease 2019 (COVID-19); Non-steroidal anti-inflammatory drugs
• ISSN: 1684-1182; 1995-9133; 1995-9133
• DOI: 10.1016/j.jmii.2020.03.034

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.