"Pharmacological profile of current drug approaches for the treatment of COVID-19"

Abstract

The SARS-Cov-2 pandemic has put an unprecedented pressure on the global health system. Since the SARS-CoV-2 outbreak and despite the strict public health measures, COVID-19 has still become a global health crisis. The treatment of patients is still mainly supportive, and the drugs studied were used compassionately. It is well known that excessive inflammation and immune response as well as oxidative damage play a crucial role in the pathogenesis of COVID-19. Several pharmaceutical agents have been used so far.

Anti-viral agents including Chloroquine and Hydroxychloroquine, Favipiravir, Lopinavir/Ritonavir, Remdesivir, Ribavirin and Umifenovir, immunodulatory agents including Interferons (Alpha and Beta), Interleukin-6 Inhibitors (Tocilizumab and Sarilumab), Interleukin-1 inhibitors (Anakinra) and JAK And BAK Kinase Inhibitors, are some of the drugs with a potential role in the treatment of COVID-19 infection. Other medications, such as steroids (Dexamethasone), Colchicine and monoclonal antibodies are described as a potential therapy for COVID-19 patients in this review.

Initial studies demonstrated favorable results with the use of chloroquine or hydroxychloroquine in patients with COVID-19, but several large-scale randomized controlled trials have demonstrated a lack of response to hydroxychloroquine and chloroquine in the treatment of COVID-19. Favipiravir and Remdesevir are promising drugs for the treatment but further studies are needed to clarify the effectiveness, Remdesevir is an FDA approved antiviral agent for the COVID-19 infection. As for ribavirin, only in vitro data on its activity on SARS-CoV-2 are available so far and the possible benefit and/or harm for treating of coronavirus-related pneumonia are still under investigation, whereas Umifenovir failed to significantly improve the outcome of COVID-19 patients.

Other treatment options include the possible use of Interferons in the treatment of COVID-19, which is generally not recommended by the COVID-19 Treatment Panel. Tocilizumab, an IL-6 inhibitor, is a monoclonal antibody with a potential role in the infection of SARS-CoV-2. Anakinra, an IL-1 inhibitor is also a promising agent, whereas JAK and BAK Kinase inhibitors are relatively new drugs with evolving safety profiles. Baricitinib is recommended by the panel in combination with remdesevir for the treatment of the disease, in hospitalized non-intubated patients. Newest treatment, which is FDA EUA approved, involves the use of bamlanivimab plus etesevimab and carisivimab plus imdevimab in specific patients.

Finally, anti-inflammatory drugs, such as corticosteroids and colchicine have been used to treat COVID-19 infection. The current evidence supports the selective use of dexamethasone, only in severe cases of COVID-19. Colchicine appears to be a promising therapeutic agent against SARS-CoV-2.

ANAGOSTOU Vasiliki