Review of Emerging Pharmacotherapy for the Treatment of Coronavirus Disease 2019

Abstract

The outbreak of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has evolved into an emergent global pandemic. Coronavirus disease 2019 (COVID-19) can manifest on a spectrum of illness from mild disease to severe respiratory failure requiring intensive care unit admission. As the incidence continues to rise at a rapid pace, critical care teams are faced with challenging treatment decisions. There is currently no widely accepted standard of care in the pharmacologic management of patients with COVID-19. Urgent identification of potential treatment strategies is a priority. Therapies include novel agents available in clinical trials or through compassionate use, and other drugs, repurposed antiviral and immunomodulating therapies. Many have demonstrated in vitro or in vivo potential against other viruses that are similar to SARS-CoV-2. Critically ill patients with COVID-19 have additional considerations related to adjustments for organ impairment and renal replacement therapies, complex lists of concurrent medications, limitations with drug administration and compatibility, and unique toxicities that should be evaluated when utilizing these therapies. The purpose of this review is to summarize practical considerations for pharmacotherapy in patients with COVID-19, with the intent of serving as a resource for health care providers at the forefront of clinical care during this pandemic.

Keywords: antivirals; cytochrome P450; dialysis; infectious disease; liver; renal.

Figure 1

SARS‐CoV‐2 Potential Pharmacologic Targets. COVID = coronavirus; CYP3A4 = cytochrome 3A4; JAK = Janus kinase; IFN = interferon; IL‐6 = interleukin 6; RNA = ribonucleic acid; SARS‐CoV‐2 = severe acute respiratory syndrome coronavirus 2; STAT = signal transducer and activator proteins.