There are currently no US Food and Drug
Administration (FDA) - approved drugs specifically for the treatment of
patients with COVID-19. At present
clinical management includes infection prevention and control measures and
supportive care, including supplementary oxygen and mechanical ventilatory
support when indicated.
Several of drugs approved for other
indications as well as several investigational drugs are being studied in
several hundred clinical trials that are underway across the world. There are
two approved drugs (chloroquine and hydroxychloroquine) and one investigational agents (remdesivir) that are currently in use in the United States for the
treatment of COVID-19 on a compassionate basis as well as in clinical trials.
Hydroxychloroquine and chloroquine are
oral prescription drugs that have been used for treatment of malaria and
certain inflammatory conditions. There are no currently available data from
Randomized Clinical Trials to inform clinical guidance on the use, dosing, or
duration of hydroxychloroquine for prophylaxis or treatment of SARS-CoV-2
infection.
A randomized controlled trial of 150 hospitalized adults in China suggests the hydroxychloroquine (HCQ) does not help clear
the virus or relieve symptoms for COVID-19 patients more than standard care
alone and has more side effects, . However, experts caution that because of
confounding issues, the trial is unable to answer convincingly the question of whether
the drug can benefit COVID-19 patients.
A systematical review of the existing clinical
evidence of HCQ use for the prevention and treatment of COVID-19 that there is no evidence supporting HCQ for
prophylaxis or treatment of COVID-19.
Hydroxychloroquine tablets
Remdesivir is a broad-spectrum antiviral
medication developed by the biopharmaceutical company Gilead Sciences. Remdesivir
inhibits viral replication through premature termination of RNA transcription
and has in-vitro activity against SARS-CoV-2 and in-vitro and in-vivo activity
against related betacoronaviruses. It is being tested as a specific treatment
for COVID-19, and has been issued an Emergency Use Authorization (EUA) in the
U.S. for those hospitalized with severe disease. It may shorten the time it
takes to recover from the infection.
The use of these agents have potential significant risk. They have a narrow therapeutic window
(the toxic dose is not much greater than the therapeutic dose). Side effects
include ocular, neurological , and cardiac toxicities. It is therefore critical not to take these medications without
physician evaluation and prescription.
The list of additional preparations being tried that
have demonstrated efficacy in diseases with similar pathophysiology, as well as
anecdotally against COVID-19, includes several monoclonal antibodies (47D11,
tocilizumab, sarilumab, others), famotidine (better known as Pepcid),
favipiravir (shortens time for viral clearance), stem cells, convalescent
plasma, and, to make thing interesting, thalidomide and sildenafil, better
known by its trade name Viagra. (Seriously. It is known to be a vasodilator in
certain other organs, and perhaps will help fight lung inflammation in
COVID-19.)
NOTE: DO NOT TAKE ANY OF THESE except by
individual physician prescription.
A novel treatment involving immunotherapy
with NK ("natural killer") cells, which are a type of lymphocyte and
a component of the innate immune system, is being tried. NK cells attack
virally infected cells and reduce the inflammation around them.
A "cytokine storm", or
overproduction of immune cells and their activating compounds, or cytokines, is
responsible for the rapid decline (high blood pressure, lung damage, organ
failure, and often rapid death) that sometimes occurs in patients who appear to
be doing well or recovering well. Overreaction of the immune system is thought by some
to be the reason that otherwise healthy young people died during the 1918-1919
influenza pandemic. Also the use of plasma from convalescent patients in a few
critically ill patients has shown rapid improvement in several cases; these
results will of course require evaluation and confirmation in formal clinical
trials.
Although there is currently no vaccine against COVID-19, there are multiple attempts develop such a vaccine, and clinical
trials to develop such vaccines. Since COVID-19 is an RNA virus, it may be
possible to develop a vaccine that will provide long-term immunity.
Read more about this at: https://www.cdc.gov/coronavirus/2019-ncov/hcp/therapeutic-options.html
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