Possible therapeutic agents for COVID-19: a comprehensive review

ABSTRACT

Introduction

Severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) has emerged in China. There are no available vaccines or antiviral drugs for COVID-19 patients. Herein, we represented possible therapeutic agents that may stand as a potential therapy against COVID-19.

Areas covered

We searched PubMed, Google Scholar, and clinicaltrials.gov for relevant papers. We showed some agents with potentially favorable efficacy, acceptable safety as well as good pharmacokinetic profiles. Several therapies are under assessment to evaluate their efficacy and safety for COVID-19. However, some drugs were withdrawn due to their side effects after demonstrating some clinical efficacy. Indeed, the most effective therapies could be organ function support, convalescent plasma, anticoagulants, and immune as well as antiviral therapies, especially anti-influenza drugs due to the similarities between respiratory viruses regarding viral entry, uncoating, and replication. We encourage giving more attention to favipiravir, remdesivir, and measles vaccine.

Expert opinion

A combination, at least dual or even triple therapy, of the aforementioned efficacious and safe therapies is greatly recommended for COVID-19. Further, patients should have a routine assessment for their coagulation and bleeding profiles as well as their inflammatory and cytokine concentrations.

KEYWORDS:

• Coronavirus
• infection
• covid-19
• outbreak
• bat
• pandemic
• therapy
• drug
• vaccine
• immunization

Article highlights

• SARS-CoV-2 is now much more hazardous than expected compared to previous outbreaks.

• There are no available vaccines or specific antiviral drugs for COVID-19 patients. Consequently, the current treatment protocols are depending mainly on supportive treatment and trying previously used drugs due to our experience on the posology, safety profile, side effects, as well as drug interactions of these drugs.

• Herein, we investigated the potential therapeutics for COVID-19 patients based on the previously documented antiviral activity either against SARS- and MERS-CoVs or other viral infections and based on the ongoing or published SARS-CoV-2 studies.

• Several therapies are under assessment to evaluate their efficacy and safety for COVID-19. On the other hand, some drugs have been withdrawn due to their side effects after demonstrating some clinical efficacy while COVID-19, as of today, is essentially untreatable, except for supportive management.

• Indeed, the most effective therapies could be organ function support, convalescent plasma, anticoagulants, and antiviral therapy.

• We encourage giving more attention to favipiravir, remdesivir, and measles vaccine.

• Convalescent plasma was associated with reduced mortality during the 1918 influenza, SARS, 2009 influenza H1N1, and Ebola outbreaks.

• ALPS and ECMO should be considered under strict indications and contraindications or that leads to waste of resources and additional complications.

• Tocilizumab, as an anti-IL-6 receptor, has a promising therapeutic potential.

• Antibiotics for pneumonia are essential in case of bacterial infection only otherwise it may fuel bacterial resistance.

• Undoubtedly, a combination, at least dual or even triple therapy, of the aforementioned efficacious and safe therapies is greatly recommended for COVID-19 due to the disease nature but giving great attention that mild, moderate, and severe patients may have different regimens and combinations based on the disease severity is important as well.

• Further, patients should have a routine assessment for their coagulation and bleeding profiles as well as their inflammatory and cytokine concentrations.

Declaration of interest

The authors have no 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. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

Reviewer disclosures

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

Additional information

Funding

This paper was not funded.