Antiviral treatment of COVID-19

Serap Şimşek Yavuz, Serhat Ünal, Serap Şimşek Yavuz, Serhat Ünal

Abstract

Currently, there is not any specific effective antiviral treatment for COVID-19. Although most of the COVID-19 patients have mild or moderate courses, up to 5%–10% can have severe, potentially life threatening course, there is an urgent need for effective drugs. Optimized supportive care remains the mainstay of therapy. There have been more than 300 clinical trials going on, various antiviral and immunomodulating agents are in various stages of evaluation for COVID-19 in those trials and some of them will be published in the next couple of months. Despite the urgent need to find an effective antiviral treatment for COVID-19 through randomized controlled studies, certain agents are being used all over the world based on either in-vitro or extrapolated evidence or observational studies. The most frequently used agents both in Turkey and all over the world including chloroquine, hydroxychloroquine, lopinavir/ritonavir, favipiravir and remdesivir will be reviewed here .Nitazoxanide and ivermectin were also included in this review as they have recently been reported to have an activity against SARS-CoV-2 in vitro and are licensed for the treatment of some other human infections.

Keywords: Covid-19; Sars-CoV-2; antiviral.

Conflict of interest statement

CONFLICT OF INTEREST:

The authors declare no competing interests.

This work is licensed under a Creative Commons Attribution 4.0 International License.

References

    1. Treatment. In: Kamps BS, Hoffmann C, eds. Covid Reference. Website . 2020.
    1. McCreary EK Pogue JM Coronavirus disease 2019 treatment: a review of early and emerging options. Open Forum Infectious Diseases. 2020;7:ofaa105–ofaa105.
    1. Kalil AC Treating COVID-19–Off-Label Drug Use, Compassionate Use, and Randomized Clinical Trials During Pandemics. JAMA. 2020;10
    1. Uyeki TM Bernstein HH Bradley JS Englund JA File TM Clinical practice guidelines by the infectious diseases society of America: 2018 update on diagnosis, treatment, chemoprophylaxis, and institutional outbreak management of seasonal influenzaa. Clinical Infectious Disesases. 2019;68
    1. Chan KS Treatment of severe acute respiratory syndrome with lopinavir/ritonavir: a multicentre retrospective matched cohort study. Hong Kong Medical Journal. 2003;9:399–406.
    1. Schrezenmeie E Dörner T Mechanisms of action of hydroxychloroquine and chloroquine: implications for rheumatology. Nature Reviews Rheumatology. 2020;16:155–166.
    1. Hydroxychloroquine, a less toxic derivative of chloroquine, is effective in inhibiting SARS-CoV-2 infection in vitro. Cell Discovery. 2020.
    1. Wang M Cao R Zhang L Yang X Liu J Remdesivir and chloroquine effectively inhibit the recently emerged novel coronavirus (2019-nCoV) in vitro. Cell Research. 2020;30:269–271.
    1. Lu CC Chen MY Chang YL Potential therapeutic agents against COVID-19: What we know so far. Journal of the Chinese Medical Association. 2020;10
    1. Yao X Ye F Zhang Z Cui C Huang B In vitro antiviral activity and projection of optimized dosing design of hydroxychloroquine for the treatment of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) Clinical Infectious Diseases. 2020;10
    1. Barlow A Landolf KM Barlow B Yeung SYA Heavner JJ Review of emerging pharmacotherapy for the reatment of coronavirus disease 2019. Pharmacotherapy. 2020;10
    1. Gao J Tian Z Yang X Breakthrough: Chloroquine phosphate has shown apparent efficacy in treatment of COVID-19 associated pneumonia in clinical studies. Bioscience Trends. 2020;14:72–72.
    1. Chen J A pilot study of hydroxychloroquine in treatment of patients with common coronavirus disease-19 (COVID-19. 2020;10
    1. Gautret P Hoang VT Hydroxychloroquine and azithromycin as a treatment of COVID-19: results of an open-label non-randomized clinical trial. International Journal of Antimicrobial Agents. 2020;10
    1. Gautret P Parola P Hoang VT 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. Travel Medicine and Infectious Disease. 2020;10
    1. Chen CY Wang FL Lin CC Chronic hydroxychloroquine use associated with QT prolongation and refractory ventricular arrhythmia. Clinical Toxicology. 2006;44:173–175.
    1. Kezerashvili A Khattak H Barsky A Nazari R Fisher JD Azithromycin as a cause of QT-interval prolongation and torsade de pointes in the absence of other known precipitating factors. Journal of Interventional Cardiac Electrophysiology. 2007;18:243–246.
    1. Furuta Y Komeno T Nakamura T Favipiravir(T-705), a broad spectrum inhibitor of viral RNA polymerase. Proceedings of the Japan Academy Series B. 2017;93:449–463.
    1. Favipiravir: pharmacokinetics and concerns about clinical trials for 2019-nCoV infection. Clinical Pharmacology & Therapeutics. 2020.
    1. Sissoko D Laouenan C Folkesson E Lebing AB Beavogui AH Experimental treatment with favipiravir for Ebola virus disease (the JIKI trial): a historically controlled, single-arm proof-of-concept trial in Guinea. PLoS Medicine. 2016;13
    1. Bai CQ Mu JS Kargbo D Song YB Niu WK Clinical and Virological Characteristics of Ebola Virus Disease Patients Treated With Favipiravir (T-705)-Sierra Leone. Clinical Infectious Diseases. 2014;63:1288–1294.
    1. Choy KT Wong AYL Kaewpreedee P Sia SF Chen D Remdesivir, lopinavir, emetine, and homoharringtonine inhibit SARS-CoV-2 replication in vitro. Antiviral Research. 2020;178:104786–104786.
    1. Cai Q Yang M Liu D Chen J Shu D Experimental treatment with favipiravir for COVID-19: an open-label control study. Engineering. 2020;10
    1. Holshue ML DeBolt C Lindquist S Lofy KH Wiesman J First Case of 2019 Novel Coronavirus in the United States . New England Journal of Medicine. 2020;382:929–936.
    1. Grein J Ohmagari N Shin D Diaz G Asperges E Compassionate use of remdesivir for patients with severe Covid-19. New England Journal of Medicine. 2020;10
    1. Choy KT Wong AYL Kaewpreedee P Sia SF Chen D Remdesivir, lopinavir, emetine, and homoharringtonine inhibit SARS-CoV-2 replication in vitro. Antiviral Research. 2020;178:104786–104786.
    1. Chu CM Cheng VC Hung IFN Wong MM Chan KH Role of lopinavir/ritonavir in the treatment of SARS: Initial virological and clinical findings. Thorax. 2004;59:252–256.
    1. Yao TT Qian JD Zhu Y Wang Y Wang GQ A systematic review of lopinavir therapy for SARS coronavirus and MERS coronavirus–A possible reference for coronavirus disease‐19 treatment option. Journal of Medical Virology. 2020;10
    1. Park SY Lee JS Son JS Ko JH Peck KR Post-exposure prophylaxis for Middle East respiratory syndrome in healthcare workers. Journal of Hospital Infection. 2019;101:42–46.
    1. Young BE Ong SWX Kalimuddin S Low JG Tan SY Epidemiologic Features and Clinical Course of Patients Infected With SARS-CoV-2 in Singapore. JAMA. 2020;10
    1. Ye XT Luo L Xia SC Sun QF Ding JG Clinical efficacy of lopinavir/ritonavir in the treatment of Coronavirus disease 2019. Pharmacological Sciences. 2020;24:3390–3396.
    1. Cao B Wang Y Wen D Liu W Wanget J A trial of lopinavir–ritonavir in adults hospitalized with severe Covid-19. . New England Journal of Medicine. 2020;10
    1. Baden LR Rubin EJ Covid-19–The Search for Effective Therapy. New England Journal of Medicine. 2020;10
    1. Early antiviral treatment contributes to alleviate the severity and improve the prognosis of patients With novel coronavirus Disease (COVID-19) Journal of Internal Medicine. 2020.
    1. Rossignol JF Nitazoxanide, a new drug candidate forthe treatment of Middle East respiratorysyndrome coronavirus. Journal of Infection and Public Health. 2016;9:227–230.
    1. Jasenosky L D Cadena C Mire CE Borisevich V Haridas V The FDA-approved oral drug nitazoxanide amplifies host antiviral responses and inhibits Ebola virus. iScience. 2019;19:1279–1290.
    1. Caly L Druce JD Catton MG Jans DA Wagstaff KM The FDA approved drug ivermectin inhibits the replication of SARS-CoV-2 in vitro. Antiviral Research. 2020;10
    1. Ketkar H Yang L Wormser GP Wang P Lack of efficacy of ivermectin for prevention of a lethal Zika virus infection in a murine system. Diagnostic Microbiology and Infectious Disease. 2019;95:38–40.

Source: PubMed

3
購読する