Summary of Emerging Treatment Options

198 views 0 04/26/2020 05/09/2020

Investigational Drugs Results in favor of the use* Results not in favor of the use** Efficacy proven

Antiviral agents
Chloroquine∆,1-3 ✓ ✓
Hydroxychloroquine∆,4-11 ✓ ✓
Hydroxychloroquine + Azithromycin∆,5,7,8,10 ✓ ✓
Ivermectin12 N/A N/A
Favipivir13,14 ✓
Lopinavir-Ritonavir15,16 ✓
Oseltamivir17 ✓
Remdesivir18,19 ✓ ✓
Convalescent plasma20 ✓

Supporting agents

Anakinra

(IL-1 receptor antagonist)

 N/A N/A
Baricitinib

(JAK 1-2 inhibitor)

 N/A N/A
Colchicine N/A N/A
Corticosteroidsλ,21 N/A N/A
Methylprednisoloneλ,22 ✓λ
Sarilumab

(IL-6 receptor inhibitor)

 N/A N/A
Tocilizumab

(IL-6 receptor inhibitor)23,24

 ✓

*: Clinical results are promising or favorable, but stronger evidence needed to support the use. Drug is still under investigation.

**: Current available clinical results are not in favor of the use or efficacy not suggested. Drug is still under investigation.

∆: FDA cautions against use of hydroxychloroquine or chloroquine for COVID-19 outside of the hospital setting or a clinical trial due to risk of heart rhythm problems.

λ: WHO, CDC and NIH generally recommend against the routine use of corticosteroids for the treatment of COVID-19 unless indicated for another reason. Possible harm was shown with its use in SARS-CoV, MERS-CoV and influenza. Methylprednisolone appeared to reduce the risk of death among patients with COVID-19 related ARDS in a retrospective observational study. This finding should be interpreted with caution because of the potential biases and the small sample size of the study.

Information found on this table comes from a rapid non-systematic review of literature of different treatments in COVID-19. This table is a summary of selected results mainly from published clinical trials and includes some pre-proof or non peer-reviewed articles as of April 26 2020. Other observational studies are also included.

 

Sources:

  1. Cortegiani A, Ingoglia Ippolito M et al. (March 10 2020). A systematic review on the efficacy and safety of chloroquine for the treatment of COVID-19. Journal of critical care. https://doi.org/10.1016/j.jcrc.2020.03.005
  2. Gao J, Tian Z, Yang X (March 16 2020). Breakthrough: chloroquine phosphate has shown apparent efficacy in treatment of COVID-19 associated pneumonia in clinical studies. Biosci Trends. https://doi.org/10.5582/bst.2020.01047
  3. Borba M, Val F, Sampaio et al. (April 24 2020). Effect of High vs Low Doses of Chloroquine Diphosphate as Adjunctive Therapy for Patients Hospitalized With Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) Infection: A Randomized Clinical Trial. JAMA Network Open. https://doi.org/10.1001/jamanetworkopen.2020.8857
  4. Million M, Lagier J-C, Gautret et al (Pre Print April 9 2020). Early treatment of 1061 COVID-19 patients with HCQ and azithromycin. Pre print. Retrieved from : https://www.mediterranee-infection.com/wp-content/uploads/2020/04/Abstract_Raoult_EarlyTrtCovid19_09042020_vD1v.pdf
  5. Molina JM, Delaugerre C, Goff JL et al. (Pre print of March 30 2020) No evidence of rapid antiviral clearance or clinical benefit with the combination of hydroxychloroquine and azithromycin in patients with severe COVID-19 infection. Médecine et Maladies Infectieuses. Pre print. https://doi.org/doi:10.1016/j.medmal.2020.03.006
  6. Chen Z, Jijia H, Zongwei Z et al (Pre print April 10 2020). Efficacy of hydroxychloroquine in patients with COVID-19: results of a randomized clinical trial. Pre print. https://doi.org/10.1101/2020.03.22.20040758
  7. Gautret P, Lagier JC, Parola P et al (Pre print March 27 2020). Clinical and microbiological effect of a combination of hydroxychloroquine and azithromycin in 80 COVID-19 patients with at least a six-day follow up: an observational study. Pre print. https://www.mediterranee-infection.com/wp-content/uploads/2020/03/COVID-IHU-2-1.pdf?fbclid=IwAR0-uBG8W7rsx0YxGUfILvwl-Hr5uKs0VGyQEFqkhSL0pk3IvyQ7BF_KAwE
  8. Gautret P,  Lagier  J-C,  Parola  P et al (March 20 2020). Hydroxychloroquine  and azithromycin as a treatment of COVID-19: results of an open-label non-randomized clinical trial. International Journal of Antimicrobial Agents. https://doi.org/10.1016/j.ijantimicag.2020.105949
  9. Chen J, Liu D, Liu L et al. (March 6 2020). A pilot study of hydroxychloroquine in treatment of patients with common coronavirus disease-19 (COVID-19). Journal of ZheJiang University (Medical Sciences) https://doi.org/10.3785/j.issn.1008-9292.2020.03.03
  10. Magagnoli J, Narendran S, Pereira F et al. (Pre print April 23 2020). Outcomes of hydroxychloroquine usage in United States veterans hospitalized with Covid-19. Pre print. https://doi.org/10.1101/2020.04.16.20065920
  11. Geleris J, Sun Y, Platt et al. (May 7 2020). Observational Study of Hydroxychloroquine in Hospitalized Patients with Covid-19. NEJM. https://doi.org/10.1056/NEJMoa2012410
  12. Caly L, Druce, J, Catton, M et al. (April 3, 2020). The FDA-approved Drug Ivermectin inhibits the replication of SARS-CoV-2 in vitro. Antiviral Research. https://doi.org/10.1016/j.antiviral.2020.104787
  13. Dong L., Hu S., Gao J. (February 29, 2020). Discovering drugs to treat coronavirus disease 2019 (COVID-19). J-Stage Drug Discoveries & Therapeutics. https://doi.org/10.5582/ddt.2020.01012
  14. Du Y.X., Che X.P. (April 4, 2020). Favipiravir: pharmacokinetics and concerns about clinical trials for 2019-nCoV-infection. Clinical Pharmacology & Therapeutics. https://doi.org/10.1002/cpt.1844
  15. Cao B, Wang Y, Wen B et al. (March 18 2020). A Trial of Lopinavir–Ritonavir in Adults Hospitalized with Severe Covid-19. N Engl J Med. http://doi.org/10.1056/NEJMoa2001282
  16. Deng L, Li C, Zeng Q et al. (March 6 2020). Arbidol combined with LPV/r versus LPV/r alone against CoronaVirus Disease 2019: A retrospective cohort study. Journal of Infection. https://doi.org/10.1016/j.jinf.2020.03.002
  17. Chen N, Zhou M, Dong X et al. (January 30 2020). Epidemiological and clinical characteristics of 99 cases of 2019 novel coronavirus pneumonia inWuhan, China: a descriptive study. Lancet. https://doi.org/10.1016/S0140-6736(20)30211-7
  18. Grein J, Ohmagari N, Shin D et al. (April 10 2020). Compassionate use of remdesivir for patients with severe Covid-19. N Engl J Med. https://doi.org/10.1056/NEJMoa2007016
  19. Wang Y, Zhang D, Du G et al. (April 29 2020). Remdesivir in adults with severe COVID-19: a randomised, double-blind, placebo-controlled, multicentre trial. Lancet. https://doi.org/10.1016/S0140-6736(20)31022-9
  20. Shen C., Wang Z., Zhao F., et al (March 27, 2020). Treatment of 5 Critically Ill Patients With COVID-19 With Convalescent Plasma. JAMA. https://doi.org/10.1001/jama.2020.4783
  21. Russell CD, Millar JE, Baillie JK (February 07 2020). Clinical evidence does not support corticosteroid treatment for 2019-nCoV lung injury. Lancet. https://doi.org/10.1016/S0140-6736(20)30317-2
  22. Wu C, Chen X, Cai Y et al. (13 March 2020). Risk Factors Associated With Acute Respiratory Distress Syndrome and Death in Patients With Coronavirus Disease 2019 Pneumonia in Wuhan, China. JAMA Internal Medecine. https://doi.org/10.1001/jamainternmed.2020.0994
  23. Xu X, Han M, Li T et al. (March 5 2020). Effective treatment of severe COVID-19 patients with Tocilizumab.  Available on chinaXiv website. chinaXiv:202003.00026v1
  24. Luo P, Liu Y, Qiu L et al. (April 6 2020). Tocilizumab treatment in COVID-19: a single center experience. J Med Virol. https://doi.org/10.1002/jmv.25801

 

 

 

 

 

 

 

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