Pharmacotherapy in COVID-19; A narrative review for emergency providers.
TLDR
The effectiveness of current therapy options for COVID-19 is summarized and the controversial use of non-steroidal anti-inflammatory drugs (NSAIDs), angiotensin converting enzyme (ACE) inhibitors, and angiotENSin receptor blockers (ARBs) is addressed.Abstract:
Introduction The COVID-19 pandemic has been particularly challenging due to a lack of established therapies and treatment guidelines. With the rapid transmission of disease, even the off-label use of available therapies has been impeded by limited availability. Several antivirals, antimalarials, and biologics are being considered for treatment at this time. The purpose of this literature review is to synthesize the available information regarding treatment options for COVID-19 and serve as a resource for health care professionals. Objectives This narrative review was conducted to summarize the effectiveness of current therapy options for COVID-19 and address the controversial use of non-steroidal anti-inflammatory drugs (NSAIDs), angiotensin converting enzyme (ACE) inhibitors, and angiotensin receptor blockers (ARBs). PubMed and SCOPUS were queried using a combination of the keywords “COVID 19,” “SARS-CoV-2,” and “treatment.” All types of studies were evaluated including systematic reviews, case-studies, and clinical guidelines. Discussion There are currently no therapeutic drugs available that are directly active against SARS-CoV-2; however, several antivirals (remdesivir, favipiravir) and antimalarials (chloroquine, hydroxychloroquine) have emerged as potential therapies. Current guidelines recommend combination treatment with hydroxychloroquine/azithromycin or chloroquine, if hydroxychloroquine is unavailable, in patients with moderate disease, although these recommendations are based on limited evidence. Remdesivir and convalescent plasma may be considered in critical patients with respiratory failure; however, access to these therapies may be limited. Interleukin-6 (IL-6) antagonists may be used in patients who develop evidence of cytokine release syndrome (CRS). Corticosteroids should be avoided unless there is evidence of refractory septic shock, acute respiratory distress syndrome (ARDS), or another compelling indication for their use. ACE inhibitors and ARBs should not be discontinued at this time and ibuprofen may be used for fever. Conclusion There are several ongoing clinical trials that are testing the efficacy of single and combination treatments with the drugs mentioned in this review and new agents are under development. Until the results of these trials become available, we must use the best available evidence for the prevention and treatment of COVID-19. Additionally, we can learn from the experiences of healthcare providers around the world to combat this pandemic.read more
Citations
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Individuals with obesity and COVID-19: A global perspective on the epidemiology and biological relationships.
Barry M. Popkin,Barry M. Popkin,Shufa Du,William R. Green,Melinda A. Beck,Taghred Algaith,Christopher H. Herbst,Reem Alsukait,Reem Alsukait,Mohammed Alluhidan,Nahar Alazemi,Meera Shekar +11 more
TL;DR: Mechanistic pathways for individuals with obesity are presented in depth for factors linked with COVID‐19 risk, severity and their potential for diminished therapeutic and prophylactic treatments among these individuals.
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Nanoceria as a possible agent for the management of COVID-19.
Prince Allawadhi,Amit Khurana,Sachin Allwadhi,Kamaldeep Joshi,Gopinath Packirisamy,Kala Kumar Bharani +5 more
TL;DR: Nanoceria, a versatile rare earth nanoparticle with remarkable catalase and superoxide dismutase mimetic redox regenerative properties, is hypothesize that NC owing to its unique pharmacological properties might be an attractive preclinical candidate to win the battle over COVID-19.
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Immunotherapeutic approaches to curtail COVID-19.
TL;DR: Gaining more knowledge about the detailed pathogenesis of SARS-CoV-2, its interplay with the immune system, and viral-mediated responses are crucial to identify efficient preventive and therapeutic approaches.
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Luteolin and abyssinone II as potential inhibitors of SARS-CoV-2: an in silico molecular modeling approach in battling the COVID-19 outbreak
TL;DR: In this paper, a collection of 43 flavonoids of 7 different classes with previously recorded antiviral activity was evaluated via computational and bioinformatics tools for their impeding capacity against SARS-CoV-2.
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A Review of Treatment of Coronavirus Disease 2019 (COVID-19): Therapeutic Repurposing and Unmet Clinical Needs
TL;DR: Traditional Chinese medicine with antiviral effects on SARS-CoV-2 and immune-modulation is widely used for COVID-19 patients in China, and is worthy of further studies.
References
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Wei-jie Guan,Zhengyi Ni,Yu Hu,Wenhua Liang,Chun-Quan Ou,Jianxing He,Lei Liu,Hong Shan,Chunliang Lei,David S.C. Hui,Bin Du,Lanjuan Li,Guang Zeng,Kowk-Yung Yuen,Ruchong Chen,Chun-Li Tang,Tao Wang,Ping-Yan Chen,Jie Xiang,Shiyue Li,Jinlin Wang,Zi-jing Liang,Yi-xiang Peng,Li Wei,Yong Liu,Ya-hua Hu,Peng Peng,Jian-ming Wang,Ji-yang Liu,Zhong Chen,Gang Li,Zhi-jian Zheng,Shao-qin Qiu,Jie Luo,Chang-jiang Ye,Shao-yong Zhu,Nanshan Zhong +36 more
TL;DR: During the first 2 months of the current outbreak, Covid-19 spread rapidly throughout China and caused varying degrees of illness, and patients often presented without fever, and many did not have abnormal radiologic findings.
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Risk Factors Associated With Acute Respiratory Distress Syndrome and Death in Patients With Coronavirus Disease 2019 Pneumonia in Wuhan, China
Chaomin Wu,Xiaoyan Chen,Yanping Cai,Jia’an Xia,Xing Zhou,Sha Xu,Han-Ping Huang,Li Zhang,Xia Zhou,Chunling Du,Yuye Zhang,Juan Song,Sijiao Wang,Yencheng Chao,Zeyong Yang,Jie Xu,Xin Zhou,Dechang Chen,Weining Xiong,Lei Xu,Feng Zhou,Jinjun Jiang,Chunxue Bai,Zheng Junhua,Yuanlin Song +24 more
TL;DR: Although high fever was associated with the development of ARDS, it was also associated with better outcomes among patients with ARDS and treatment with methylprednisolone may be beneficial for patients who develop ARDS.
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Remdesivir and chloroquine effectively inhibit the recently emerged novel coronavirus (2019-nCoV) in vitro.
Manli Wang,Ruiyuan Cao,Leike Zhang,Xing-Lou Yang,Jia Liu,Mingyue Xu,Zhengli Shi,Zhihong Hu,Wu Zhong,Gengfu Xiao +9 more
TL;DR: This study evaluated the antiviral efficiency of five FAD-approved drugs including ribavirin, penciclovir, nitazoxanide, nafamostat, chloroquine and two well-known broad-spectrum antiviral drugs remdesivir and favipiravir against a clinical isolate of 2019-nCoV in vitro.
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First Case of 2019 Novel Coronavirus in the United States.
Michelle Holshue,Chas DeBolt,Scott Lindquist,Kathy H Lofy,John Wiesman,Hollianne Bruce,Christopher Spitters,Keith M. Marzilli Ericson,Sara Wilkerson,Ahmet Tural,George Diaz,Amanda C. Cohn,LeAnne Fox,Anita Patel,Susan I. Gerber,Lindsay Kim,Suxiang Tong,Xiaoyan Lu,Steve Lindstrom,Mark A. Pallansch,William C. Weldon,Holly M. Biggs,Timothy M. Uyeki,Satish K. Pillai +23 more
TL;DR: This case highlights the importance of close coordination between clinicians and public health authorities at the local, state, and federal levels, as well as the need for rapid dissemination of clinical information related to the care of patients with this emerging infection.
Journal ArticleDOI
A Trial of Lopinavir-Ritonavir in Adults Hospitalized with Severe Covid-19.
Bin Cao,Yeming Wang,Danning Wen,Wen Liu,Jingli Wang,Guohui Fan,Lianguo Ruan,Bin Song,Yanping Cai,Ming Wei,Xingwang Li,Jia'an Xia,Nanshan Chen,Jie Xiang,Ting Yu,Tao Bai,Xuelei Xie,Li Zhang,Caihong Li,Ye Yuan,Hua Chen,Huadong Li,Hanping Huang,Shengjing Tu,Fengyun Gong,Ying Liu,Yuan Wei,Chongya Dong,Fei Zhou,Xiaoying Gu,Jiuyang Xu,Zhibo Liu,Yi Zhang,Li Hui,Lianhan Shang,Ke Wang,Kunxia Li,Xia Zhou,Xuan Dong,Zhaohui Qu,Sixia Lu,Xujuan Hu,Shunan Ruan,Shanshan Luo,Jing Wu,Lu Peng,Fang Cheng,Lihong Pan,Jun Zou,Chunmin Jia,Juan Wang,Xia Liu,Shuzhen Wang,Xudong Wu,Qin Ge,Jing He,Haiyan Zhan,Fang Qiu,Li Guo,Chaolin Huang,Thomas Jaki,Frederick G. Hayden,Peter Horby,Dingyu Zhang,Chen Wang +64 more
TL;DR: In hospitalized adult patients with severe Covid-19, no benefit was observed with lopinavir–ritonavir treatment beyond standard care, and future trials in patients withsevere illness may help to confirm or exclude the possibility of a treatment benefit.
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