Covid-19: A Pharmacotherapeutic Perspective
DOI:
https://doi.org/10.22270/ajprd.v9i1.910Keywords:
Coronavirus, Wuhan Virus, Sars-Cov-2, Convalescent Plasma, Covid 19Abstract
Introduction: COVID-19 disease has been difficult to tackle owing to the lack of typical therapeutic options. Many antivirals, antimalarial, and biologics are being carefully evaluated for treatment. This literature analysis aims to shed light to the ongoing studies concerning treatment possibilities for COVID-19 and assist as a reserve for health experts.
Objectives: This literature review was done to underline the efficacy and safety of existing treatment alternatives for COVID-19 and the cautious use of non-steroidal anti-inflammatory drugs, angiotensin-converting enzyme inhibitors and angiotensin receptor blockers.
Methods: PubMed, Medline, Embase and SCOPUS were meticulously browsed utilizing an amalgamation of the keywords "COVID 19," "SARS-CoV-2," and "treatment." All categories of articles together with clinical guidelines, case-studies and systematic reviews were assessed.
Conclusions: Treatments that unswervingly target SARS-CoV-2 are not present so far; however, several antivirals (Remdesivir) and antimalarials (Hydroxychloroquine) have appeared as valuable treatment possibilities. Remdesivir and convalescent plasma may be expected to play a beneficial role in serious patients with respiratory failure. Interleukin-6 (IL-6) antagonists could also be utilized in patients who progress and display evidence of cytokine release syndrome. Corticosteroids need to be avoided lest there is a gripping indication for their usage. Available evidence for prevention and treatment of COVID-19 must be utilized till recognized treatments are derived into reality.
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References
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2. Wang JJ, Edin ML, Zeldin DC, Li C, Wang DW, Chen C. Good or bad: application of RAAS inhibitors in COVID-19 patients with cardiovascular comorbidities. Pharmacol Ther 2020 Jul 9:107628.
3. Felice C, Nardin C, Di Tanna GL, Grossi U, Bernardi E, Scaldaferri L, et al. Use of RAAS inhibitors and risk of clinical deterioration in COVID-19: results from an Italian cohort of 133 hypertensives. Am J Hyperten 2020 Jun 8.
4. South AM, Diz DI, Chappell MC. COVID-19, ACE2, and the cardiovascular consequences. Am J Physiol Heart Circ Physiol 2020 Apr 13.
5. Patrì A, Fabbrocini G. Hydroxychloroquine and ivermectin: A synergistic combination for COVID-19 chemoprophylaxis and treatment?. J Am Acad Dermatol 2020 Jun 1;82(6):e221.
6. Al‐Kofahi M, Jacobson P, Boulware DR, Matas A, Kandaswamy R, Jaber MM, et al. Finding the Dose for Hydroxychloroquine Prophylaxis for COVID‐19: The Desperate Search for Effectiveness. Clin Pharmacol Ther 2020 Apr 28.
7. Dowall SD, Bosworth A, Watson R, Bewley K, Taylor I, Rayner E, et al. Chloroquine inhibited Ebola virus replication in vitro but failed to protect against infection and disease in the in vivo guinea pig model. J Gen Virol 2015 Dec;96:3484.
8. Fantini J, Di Scala C, Chahinian H, Yahi N. Structural and molecular modeling studies reveal a new mechanism of action of chloroquine and hydroxychloroquine against SARS-CoV-2 infection. Int J Antimicrob Agents 2020 Apr 3:105960.
9. Gao J, Tian Z, Yang X. Breakthrough: chloroquine phosphate has shown apparent efficacy in treatment of COVID-19 associated pneumonia in clinical studies. Biosci Trends 2020;14:72–3.
10. Huang M, Tang T, Pang P, Li M, Ma R, Lu J, et al. Treating COVID-19 with chloroquine. J Mol Cell Biol 2020 Apr;12(4):322-5.
11. Kono M, Tatsumi K, Imai AM, Saito K, Kuriyama T, Shirasawa H. Inhibition of human coronavirus 229E infection in human epithelial lung cells (L132) by chloroquine: involvement of p38 MAPK and ERK. Antivir Res 2008;77:150–2.
12. Liu J, Cao R, Xu M, Wang X, Zhang H, Hu H, et al. Hydroxychloroquine, a less toxic derivative of chloroquine, is effective in inhibiting SARS-CoV-2 infection in vitro. Cell Discov 2020 Mar 18;6(1):1-4.
13. Mehra MR, Desai SS, Ruschitzka F, Patel AN. Hydroxychloroquine or chloroquine with or without a macrolide for treatment of COVID-19: a multinational registry analysis. Lancet 2020 May 22.
14. Naarding MA, Baan E, Pollakis G, Paxton WA. Effect of chloroquine on reducing HIV-1 replication in vitro and the DC-SIGN mediated transfer of virus to CD4+ T-lymphocytes. Retrovirology 2007;4:6.
15. Cao B, Wang Y, Wen D, Liu W, Wang J, Fan G, et al. A trial of lopinavir-ritonavir in adults hospitalized with severe Covid-19. N Engl J Med 2020;382:1787-99.
16. Chu CM, Cheng VC, Hung IF, Wong MM, Chan KH, Chan KS, et al. Role of lopinavir/ritonavir in the treatment of SARS: initial virological and clinical findings. Thorax 2004 Mar 1;59(3):252-6.
17. Hung IF, Lung KC, Tso EY, Liu R, Chung TW, Chu MY, et al. Triple combination of interferon beta-1b, lopinavir–ritonavir, and ribavirin in the treatment of patients admitted to hospital with COVID-19: an open-label, randomised, phase 2 trial. Lancet 2020 May 30;395(10238):1695-704.
18. Lim J, Jeon S, Shin HY, Kim MJ, Seong YM, Lee WJ, et al. Case of the index patient who caused tertiary transmission of COVID-19 infection in Korea: the application of lopinavir/ritonavir for the treatment of COVID-19 infected pneumonia monitored by quantitative RT-PCR. J Korean Med Sci 2020;35:e79.
19. Ye XT, Luo YL, Xia SC, et al. Clinical efficacy of lopinavir/ritonavir in the treatment of coronavirus disease 2019. Eur Rev Med Pharmacol Sci 2020;24:3390–6.
20. Zeng YM, Xu XL, He XQ, Tang SQ, Li Y, Huang YQ, et al. Comparative effectiveness and safety of ribavirin plus interferon-alpha, lopinavir/ritonavir plus interferon-alpha, and ribavirin plus lopinavir/ritonavir plus interferon-alpha in patients with mild to moderate novel coronavirus disease 2019: study protocol. Chin Med J (Engl) 2020;133:1132–4.
21. Geleris J, Sun Y, Platt J, Zucker J, Baldwin M, Hripcsak G, et al. Observational study of hydroxychloroquine in hospitalized patients with Covid-19. N Engl J Med 2020 May 7.
22. Wang M, Cao R, Zhang L, Yang X, Liu J, Xu M, et al. Remdesivir and chloroquine effectively inhibit the recently emerged novel coronavirus (2019-nCoV) in vitro. Cell Res 2020;30:269–71.
23. Choy KT, Wong AY, Kaewpreedee P, Sia SF, Chen D, Hui KP, et al. Remdesivir, lopinavir, emetine, and homoharringtonine inhibit SARS-CoV-2 replication in vitro. Antiviral Res 2020 Apr 3:104786.
24. Agostini ML, Andres EL, Sims AC, Graham RL, Sheahan TP, Lu X, et al. Coronavirus susceptibility to the antiviral remdesivir (GS-5734) is mediated by the viral polymerase and the proofreading exoribonuclease. MBio 2018 May 2;9(2).
25. Beigel JH, Tomashek KM, Dodd LE, Mehta AK, Zingman BS, Kalil AC, et al. Remdesivir for the treatment of Covid-19- preliminary report. N Engl J Med 2020 May 22.
26. Elfiky AA. Ribavirin, Remdesivir, Sofosbuvir, Galidesivir, and Tenofovir against SARS-CoV-2 RNA dependent RNA polymerase (RdRp): A molecular docking study. Life Sci 2020 Mar 25:117592.
27. Madsen LW. Remdesivir for the Treatment of Covid-19-Final Report. N Engl J Med 2020 Oct 8.
28. Pepperrell T, Pilkington V, Owen A, Wang J, Hill AM. Review of safety and minimum pricing of nitazoxanide for potential treatment of COVID-19. J Virus Erad 2020 Apr;6(2):52.
29. Tan Q, Duan L, Ma Y, Wu F, Huang Q, Mao K, et al. Is oseltamivir suitable for fighting against COVID-19: In silico assessment, in vitro and retrospective study. Bioorg Chem. 2020 Nov 1;104:104257.
30. Silva Arouche TD, Reis AF, Martins AY, S Costa JF, Carvalho Junior RN, JC Neto AM. Interactions Between Remdesivir, Ribavirin, Favipiravir, Galidesivir, Hydroxychloroquine and Chloroquine with Fragment Molecular of the COVID-19 Main Protease with Inhibitor N3 Complex (PDB ID: 6LU7) Using Molecular Docking. J Nanosci Nanotechnol 2020 Dec 1;20(12):7311-23.
31. Khambholja K, Asudani D. Potential repurposing of Favipiravir in COVID-19 outbreak based on current evidence. Travel Med Infect Dis 2020 May;35:101710.
32. Huang D, Yu H, Wang T, Yang H, Yao R, Liang Z. Efficacy and safety of umifenovir for coronavirus disease 2019 (COVID‐19): A systematic review and meta‐analysis. J Med Virol 2020 Jul 3.
33. Zhou Q, Chen V, Shannon CP, Wei XS, Xiang X, Wang X, et al. Interferon-α2b Treatment for COVID-19. Front Immunol. 2020 May 15;11:1061.
34. 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 Res 2020 Apr 3:104787.
35. Patrì A, Fabbrocini G. Hydroxychloroquine and ivermectin: A synergistic combination for COVID-19 chemoprophylaxis and treatment?. J Am Acad Dermatol 2020 Jun 1;82(6):e221.
36. Chaccour C, Hammann F, Ramón-García S, Rabinovich NR. Ivermectin and COVID-19: Keeping Rigor in Times of Urgency. Am J Trop Med Hyg 2020 Jun;102(6):1156.
37. Schmith VD, Zhou J, Lohmer LR. The Approved Dose of Ivermectin Alone is not the Ideal Dose for the Treatment of COVID‐19. Clin Pharmacol Ther 2020 Jan 1.
38. Gautret P, Lagier JC, Parola P, Meddeb L, Mailhe M, Doudier B, et al. Hydroxychloroquine and azithromycin as a treatment of COVID-19: results of an open-label non-randomized clinical trial. Int J Antimicrob Ag 2020 Mar 20:105949.
39. Javelot H, El-Hage W, Meyer G, Becker G, Michel B, Hingray C. COVID-19 and (hydroxy) chloroquine-Azithromycin combination: Should we take the risk for our patients?. Br J Clin Pharmacol 2020 Jun;86(6):1176-7.
40. Pani A, Lauriola M, Romandini A, Scaglione F. Macrolides and viral infections: focus on azithromycin in COVID-19 pathology. Int J Antimicrob Ag 2020 Jun 10:106053.
41. Damle B, Vourvahis M, Wang E, Leaney J, Corrigan B. Clinical Pharmacology Perspectives on the Antiviral Activity of Azithromycin and Use in COVID‐19. Clin Pharmacol Ther 2020 Apr 17.
42. Molina JM, Delaugerre C, Le Goff J, Mela-Lima B, Ponscarme D, Goldwirt L, et al. No evidence of rapid antiviral clearance or clinical benefit with the combination of hydroxychloroquine and azithromycin in patients with severe COVID-19 infection. Med Mal Infect 2020 Mar 30;50(384):30085-8.
43. Cavalcanti AB, Zampieri FG, Rosa RG, Azevedo LC, Veiga VC, Avezum A, et al. Hydroxychloroquine with or without Azithromycin in Mild-to-Moderate Covid-19. N Engl J Med 2020 Jul 23.
44. Ulrich H, Pillat MM. CD147 as a target for COVID-19 treatment: suggested effects of azithromycin and stem cell engagement. Stem Cell Rev 2020 Apr:1-7.
45. Qaseem A, Yost J, Etxeandia-Ikobaltzeta I, Miller MC, Abraham GM, Obley AJ, et al. Should clinicians use chloroquine or hydroxychloroquine alone or in combination with Azithromycin for the prophylaxis or treatment of COVID-19? Living practice points from the American College of Physicians (Version 1). Ann Intern Med 2020 Jul 21;173(2).
46. Scaroni C, Armigliato M, Cannavò S. COVID-19 outbreak and steroids administration: are patients treated for Sars-Cov-2 at risk of adrenal insufficiency?. J Endocrinol Invest 2020 Apr 16:1-2.
47. Theoharides TC, Conti P. Dexamethasone for COVID-19? Not so fast. J Biol Regul Homeost Agents 2020 Jun 4;34(3):10-23812.
48. Wilkinson E. RECOVERY trial: the UK covid-19 study resetting expectations for clinical trials. BMJ 2020 Apr 28;369.
49. Horby P, Lim WS, Emberson JR, Mafham M, Bell JL, Linsell L, et al. Dexamethasone in Hospitalized Patients with Covid-19-Preliminary Report. N Engl J Med 2020 Jul.
50. RECOVERY Collaborative Group. Dexamethasone in hospitalized patients with covid-19—preliminary report. New England Journal of Medicine. 2020 Jul 17. Available from: https://www.nejm.org/doi/full/10.1056/NEJMoa2021436.
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Published
2021-02-15
How to Cite
Khan, B. H., Singh, S., Ahmad, J., & Ahmad, F. (2021). Covid-19: A Pharmacotherapeutic Perspective. Asian Journal of Pharmaceutical Research and Development, 9(1), 183–189. https://doi.org/10.22270/ajprd.v9i1.910
Issue
Section
Review Articles
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