- For treatment of COVID-19, consider convalescent plasma, IL-6 antagonists.
- Patients taking angiotensin-converting enzyme (ACE) inhibitors and angiotensin receptor blockers (ARBs) should continue them.
- Data regarding antimalarials are limited, and the drugs are not benign.
Why this matters
- Before trials emerge, this article synthesizes what little we know.
- Narrative review of 18 articles on pharmaceutical therapy for COVID-19.
- Nucleotide analogs, e.g., remdesivir:
- Consider for severe disease and respiratory failure.
- Do not use with hydroxychloroquine.
- Nucleoside analogs:
- Not recommended.
- Trials of favipiravir underway.
- Ribavirin is too toxic at required doses.
- Protease inhibitors, e.g., lopinavir/ritonavir:
- Successful in SARS.
- Controversial in COVID-19; not recommended.
- Antimalarials, e.g., chloroquine and hydroxychloroquine:
- Based on extremely limited data, FDA granted emergency authorization for hydroxychloroquine.
- Both can be toxic, even lethal.
- Avoid routine use.
- Consider in refractory septic shock, severe acute respiratory distress syndrome.
- Biologics, e.g., tocilizumab and sarilumab:
- Consider if cytokine release syndrome.
- Convalescent plasma:
- Approved for severe and immediately life-threatening COVID-19 infections.
- NSAIDs, ACE inhibitors, ARBs:
- Evidence does not support increased risk.
- Small sample sizes; in vitro or in animal models.
- A study of hospitalized COVID-19 patients appearing in preprint April 15 (n=181) found no difference with hydroxychloroquine treatment vs without in a composite endpoint of ICU transfer or death.