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Review
. 2021 Dec:59:100794.
doi: 10.1016/j.drup.2021.100794. Epub 2021 Dec 9.

An update on drugs with therapeutic potential for SARS-CoV-2 (COVID-19) treatment

Affiliations
Review

An update on drugs with therapeutic potential for SARS-CoV-2 (COVID-19) treatment

Sylwester Drożdżal et al. Drug Resist Updat. 2021 Dec.

Abstract

The COVID-19 pandemic is one of the greatest threats to human health in the 21st century with more than 257 million cases and over 5.17 million deaths reported worldwide (as of November 23, 2021. Various agents were initially proclaimed to be effective against SARS-CoV-2, the etiological agent of COVID-19. Hydroxychloroquine, lopinavir/ritonavir, and ribavirin are all examples of therapeutic agents, whose efficacy against COVID-19 was later disproved. Meanwhile, concentrated efforts of researchers and clinicians worldwide have led to the identification of novel therapeutic options to control the disease including PAXLOVID™ (PF-07321332). Although COVID-19 cases are currently treated using a comprehensive approach of anticoagulants, oxygen, and antibiotics, the novel Pfizer agent PAXLOVID™ (PF-07321332), an investigational COVID-19 oral antiviral candidate, significantly reduced hospitalization time and death rates, based on an interim analysis of the phase 2/3 EPIC-HR (Evaluation of Protease Inhibition for COVID-19 in High-Risk Patients) randomized, double-blind study of non-hospitalized adult patients with COVID-19, who are at high risk of progressing to severe illness. The scheduled interim analysis demonstrated an 89 % reduction in risk of COVID-19-related hospitalization or death from any cause compared to placebo in patients treated within three days of symptom onset (primary endpoint). However, there still exists a great need for the development of additional treatments, as the recommended therapeutic options are insufficient in many cases. Thus far, mRNA and vector vaccines appear to be the most effective modalities to control the pandemic. In the current review, we provide an update on the progress that has been made since April 2020 in clinical trials concerning the effectiveness of therapies available to combat COVID-19. We focus on currently recommended therapeutic agents, including steroids, various monoclonal antibodies, remdesivir, baricitinib, anticoagulants and PAXLOVID™ summarizing the latest original studies and meta-analyses. Moreover, we aim to discuss other currently and previously studied agents targeting COVID-19 that either show no or only limited therapeutic activity. The results of recent studies report that hydroxychloroquine and convalescent plasma demonstrate no efficacy against SARS-CoV-2 infection. Lastly, we summarize the studies on various drugs with incoherent or insufficient data concerning their effectiveness, such as amantadine, ivermectin, or niclosamide.

Keywords: Baricitinib; COVID-19; Casirivimab; Dexamethasone; Imdevimab; Omicron; Paxlovid; Remdesivir; SARS-CoV-2; Sotrovimab; Tocilizumab.

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Figures

Fig. 1
Fig. 1
Schematic depiction of SARS-Cov-2. SARS-Cov-2 is an enveloped, spherical virus belonging to the coronaviridae family. RNA – genomic, positive-sense, single-stranded RNA, M – membrane protein, S – spike protein, N – nucleocapsid protein, E – envelope protein.
Fig. 2
Fig. 2
Examples of drugs proposed for the treatment of SARS-CoV-2. Structural renderings of Hydroxychloroquine (antimalarial drug, potential blocker of viral maturation), Baricitinib (anti-inflammatory: blocker of JAK-1, JAK-2 kinases), Dexamethasone (steroid anti-inflammatory drug), and Remdesivir (blocks viral replication) are shown.
Fig. 3
Fig. 3
Schematic representation of available anti-SARS-CoV-2 vaccines. The principle, main components and mechanism of action of each vaccine type has been explained in detail in the text.
Fig. 4
Fig. 4
The viral cycle of SARS-CoV-2 and the Remdesivir target. Remdesivir is an inhibitor of the RNA-replicase (RdRp), therefore inhibition of this enzyme impairs the replication of the viral genome and hence, blocks the life cycle of the whole virus, or renders it defective.
Fig. 5
Fig. 5
Graphical representation of currently recommended therapeutic agents depending on the clinical condition.Top shows the natural course of COVID-19 infection. The symptomatic phase occurs after incubation at >20 % infection. Out of patients in critical condition even around 50 % die. Bottom shows suggested therapeutic interventions depending on the course of the disease 80 % – mild course of the disease; neutralizing antibodies recommended if high risk of disease progression. 15 % - severe course of the disease; dexamethasone and remdesivir recommended for patients with SpO2 ≤94 % on room air; if rapidly increasing oxygen need and systemic inflammation – consider baricitinib or tocilizumab. 5% - acute respiratory distress syndrome (ARDS) or multi-organ failure develops; use dexamethasone and consider tocilizumab.

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