The time to offer treatments for COVID-19

ABSTRACT

Background: COVID-19 has several overlapping phases. Treatments to date have focused on the late stage of disease in hospital. Yet, the pandemic is by propagated by the viral phase in out-patients. The current public health strategy relies solely on vaccines to prevent disease.Methods: We searched the major national registries, pubmed.org, and the preprint servers for all ongoing, completed and published trial results.Results: As of 2/15/2021, we found 111 publications reporting findings on 14 classes of agents, and 9 vaccines. There were 62 randomized controlled studies, the rest retrospective observational analyses. Only 21 publications dealt with outpatient care. Remdesivir and high titer convalescent plasma have emergency use authorization for hospitalized patients in the U.S.A. There is also support for glucocorticoid treatment of the COVID-19 respiratory distress syndrome. Monoclonal antibodies are authorized for outpatients, but supply is inadequate to treat all at time of diagnosis. Favipiravir, ivermectin, and interferons are approved in certain countries.Expert Opinion: Vaccines and antibodies are highly antigen specific, and new SARS-Cov-2 variants are appearing. We call on public health authorities to authorize treatments with known low-risk and possible benefit for outpatients in parallel with universal vaccination.

KEYWORDS:

• SARS-Cov-2
• covid-19
• hcq
• remdesivir
• favipiravir
• interferon-λ
• interferon-β-1
• convalescent plasma
• synthetic anti-spike protein antibodies
• ivermectin

Article highlights

• COVID-19 has characteristic phases, beginning as a viral influenza like illness which may then deteriorate to an inflammatory phase with a subsequent hyperinflammatory reaction characterized by cytokine release; Acute respiratory distress syndrome and a coagulopathy are responsible for mortality.

• The focus of treatment of COVID-19 has been on very ill hospitalized patients. Outpatients who do not require hospitalization are told to home quarantine with no effective treatment.

• The public health authorities have pursued universal immunization to prevent the disease, and several vaccines are now being administered to the population of the entire world. However, vaccination alone may not be sufficient to stop the disease as the virus continues to propagate with newly developing variants.

• We reviewed treatments now available to use in parallel with vaccination to fight COVID-19. We found a number of agents, some already approved and in use in a number of countries.

• We recommend that agents with known safety profile and preliminary evidence of possible benefit be used together with universal vaccination, while long-term studies proceed in parallel to prove efficacy.

This box summarizes key points contained in the article.

Declaration of interest

Dr. Binh Ngo is a speaker for Castle Biosciences. Dr. Armstrong reports grants and personal fees from Abbvie, grants and personal fees from Bristol-Myers Squibb, personal fees from Dermavant, grants from Dermira, grants and personal fees from Eli Lilly, grants and personal fees from Janssen, grants from Kyowa Hakko Kirin, grants and personal fees from LEO Pharma, grants and personal fees from Modernizing Medicine, grants and personal fees from Novartis, personal fees from Ortho-Dermatologics, personal fees from Pfizer, grants and personal fees from Regeneron, personal fees from Sanofi-Genzyme, personal fees from Science 37, Inc, grants from UCB Biopharma Dr. Dube reports grants from Gilead Sciences, outside the submitted work; Dr. Chaudhary has held stock in Gilead Sciences, Roche Holding and Moderna. Dr. Piccirillo reports personal fees from Daichii Sankyo, personal fees from GSK, personal fees from MSD, grants from Roche, grants and personal fees from AstraZeneca, non-financial support from Bayer, outside the submitted work; . Dr. Mussini is member of a Roche Data Safety Monitoring Board for tocilizumab. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial relationships or otherwise to disclose.

Supplementary material

Supplemental data for this article can be accessed here.

Correction Statement

This article has been republished with minor changes. These changes do not impact the academic content of the article.

Additional information

Funding

This paper was funded by The Rose Salter Medical Research Foundation.