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 (HCQ) 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 HCQ for prophylaxis or treatment of SARS-CoV-2 infection.
A randomized controlled trial of 150 hospitalized adults in China suggests the hydroxychloroquine 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.
Remdesvir
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