COVID-19: Potential treatments

Potential Treatments

  • Due to the pace and scale of the outbreak, current investigation of potential therapies focuses on re-purposing existing approved drugs(1)

  • On 22nd March WHO launched a global trial, SOLIDARITY, of the most promising 4 therapies, Remdesivir, Chloroquine and hydroxychloroquine, Ritonavir/Lopinavir combination, and Ritonavir/Lopinavir with Interferon-Beta. The trial is designed to be as simple as possible measuring only death or recovery and takes account of local drug availability. It is randomised but not blinded.

  • As of 8th March there were 108 registered pharmacological COVID-19 trials(2)

  • Although it is too early for any RCT data, the below potential therapies are amongst those being explored (Table 1)(1,3,4,5,6,7) 

  • The majority of potential treatments have pre-clinical data supporting their use

  • There are currently 23 ongoing clinical trials in China looking at use of Chloroquine(5)

  • There is a randomised, placebo-controlled, double blind multi-centre trial of Remdesivir in phase III which should release results in April 2020(6)

  • Meta-analysis showed a significant reduction in mortality and viral load in SARS-CoV and MERS-CoV with use of passive immunity from convalescent serum of recovered patients(3)


In case series from Wuhan, the majority of patients were prescribed anti-virals and empirical antibiotics(4).

References

1.Baron et. al. Teicoplanin: an alternative drug for the treatment of coronavirus COVID-19? Int J Antimicrob Agents. 2020 Mar 13:105944. Availabile from: https://www.ncbi.nlm.nih.gov/pubmed/32179150 [Epub ahead of print, accessed 20.3.20]

2. Aronson J, Ferner R, DeVito N, Heneghan C. COVID-19 Registered Trials – and analysis. [Online] Available from: https://www.cebm.net/oxford-covid-19/covid-19-registered-trials-and-analysis/ [Accessed 20.3.20]

3. Cunningham AC, Goh HP, Koh D. Treatment of COVID-19: old tricks for new challenges. Crit Care. 2020 Mar 16;24(1):91. Available from: https://www.ncbi.nlm.nih.gov/pubmed/32178711 [Accessed 20.3.20]

4. Mair-Jenkins J, Saavedra-Campos M, Kenneth Baillie J, Cleary P, Khaw F-M, Lim WS, et al. The effectiveness of convalescent plasma and hyperimmune immunoglobulin for the treatment of severe acute respiratory infections of viral etiology: a systematic review and exploratory meta-analysis. 2014; Available from: https://academic.oup.com/jid/article-abstract/211/1/80/799341. [Accessed 20.3.20].

5. Lai CC, Shih TP, Ko WC, Tang HJ, Hsueh PR. Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and coronavirus disease-2019 (COVID-19): The epidemic and the challenges. Int J Antimicrob Agents. 2020 Mar;55(3).Available from: https://www.sciencedirect.com/science/article/pii/S0924857920300674?via%3Dihub . [Epub ahead of print, accessed 20.3.20]

6. Cortegiani A, Ingoglia G, Ippolito M, Giarratano A, Einav S. A systematic review on the efficacy and safety of chloroquine for the treatment of COVID-19. J Crit Care. 2020 Mar 10. Available from: https://www.ncbi.nlm.nih.gov/pubmed/32173110. [Epub ahead of print, accessed 20.3.20]]

7. Ren JL, Zhang AH, Wang XJ. Traditional Chinese medicine for COVID-19 treatment. Pharmacol Res. 2020 Mar 4;155.Available from: https://www.ncbi.nlm.nih.gov/pubmed/32145402. [Epub ahead of print, accessed 20.3.20]

8. Dong L, Hu S, Gao J. Discovering drugs to treat coronavirus disease 2019 (COVID-19). Drug Discov Ther. 2020;14(1):58-60. Available from: https://www.ncbi.nlm.nih.gov/pubmed/32147628 [Accessed 20.3.20]

This page was written by Dr Rachel Coles, paediatric trainee and first published on 20th March 2020.

Updated on 24th March 2020 as WHO launched SOLIDARITY trial

Contact covid@medshr.net with questions, feedback and resources.

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