COVID-19 pharmacopeia: what we know so far


  • Jenny Blair, MD
  • Clinical Essentials
Access to the full content of this site is available only to registered healthcare professionals. Access to the full content of this site is available only to registered healthcare professionals.

Takeaway

  • 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.

Description

  • Narrative review of 18 articles on pharmaceutical therapy for COVID-19.

Key details

  • 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.
  • Corticosteroids:
    • 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.

Limitations

  • Small sample sizes; in vitro or in animal models.

Additional information

  • 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.