Pharmacological approaches to the treatment of COVID-19 patients

Abstract

The current COVID-19 pandemic has presented unprecedented challenges to the world community. No effective therapies or vaccines have yet been established. Upon the basis of homologies to similar coronaviruses, several potential drug targets have been identified and are the focus of both laboratory and clinical investigation. The rationale for several of these drug candidates is presented in this review. Emerging clinical data has revealed that severe COVID-19 disease is associated with heightened inflammatory responses and a procoagulant state, suggesting that patient treatment strategies must extend beyond antiviral agents. Effective approaches to the treatment of vulnerable patients with comorbidities will render COVID-19 substantially more manageable.

Keywords: COVID-19; SARS-CoV-2; antiviral; coagulation; coronavirus; inflammation.

Figure 1.

(A) Schematic of the COVID-19 virus showing critical viral proteins and (B) its route towards host cell infection and propagation (This figure was generated with biorender.com)

Figure 2.

Camostat, nafamostat, chloroquine, hydroxychloroquine. These drugs interfere with the initial stages of SARS-CoV-2 infection

Figure 3.

Nitanoxanide, tizoxanide, lopinavir, ritonavir, oseltamivir. These drugs can interfere with multiple stages of viral infection

Figure 4.

RNA polymerase inhibitors favipiravir, ribavirin, penciclovir and remdesivir inhibit replication of the viral RNA

Figure 5.

NSAID anti-inflammatory agents aspirin, ibuprofen, indomethacin, acetaminophen and the macrolide antibiotic azithromycin