Therapeutic options initially available for COVID-19 patients and initial clinical trials

The Coronavirus Pandemic and the Future: Virology, Epidemiology, Translational Toxicology and Therapeutics

Treatments available for COVID-19 including those still in clinical trials

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The unforeseen outbreak of the novel coronavirus 2019, designated Severe Acute Respiratory Syndrome-Coronavirus 2 (SARS-CoV-2), has created a major crisis globally. The viral disease COVID-19 that is caused by SARS-CoV-2 very rapidly developed into a global pandemic associated with significant health and economic impacts. Researchers and scientists are urgently designing and developing vaccines and testing the efficacy of drugs available to treat this deadly infection. As there are needs for novel diagnostics and therapeutics to detect and treat this viral infection, governments world-wide are taking necessary measures to develop rational vaccines against COVID-19 and even to mass produce some products before they are fully tested. This chapter focuses on updates regarding various therapeutic options available to treat the infection which include repurposed target-specific and broad-spectrum antiviral drugs as well as various Chinese and Indian medicinal plants, and convalescent plasma. Numerous stem cell-based therapies also have been under scrutiny for the possible treatment of COVID-19. These various studies have provided some evidence to support the usage of multiple alternative anti-viral therapies against COVID-19 while clinical trials are still underway.

The antiviral drug remdesivir, initially used to treat Ebola was given Emergency Use Authorisation by the FDA May 1, 2020 to treat suspected or laboratory confirmed COVID-19 in adults and children hospitalised with severe disease, two days after the National Institutes of Health’s clinical trial showed promising results in shortening the duration of disease by an average of 4 days. Subsequently dexamethasone, an off-patent steroid used since the 1960’s, resulted in about a one-third mortality reduction in a clinical trial done in the United Kingdom in patients with Covid-19 on ventilators and about a one-fifth mortality reduction in patients requiring oxygen. No benefit was seen in patients with milder disease.

The aminoquinolone antimalarial drugs chloroquine and hydroxychloroquine were used early on to treat patients with COVID-19 but randomised studies with and without azithromycin have not shown benefit and there is the potential for serious cardiac arrhythmias. Both the FDA and WHO have now recommended against using hydroxychloroquine to treat COVID-19. Clearly, more research is needed on novel options, including combination therapies, that will enable us to develop more rational countermeasures against COVID-19.

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