Treatment for COVID-19: An overview

Abstract

Coronavirus disease 2019 (COVID-19) is an infectious disease caused by coronavirus-2 (SARS-CoV-2) that causes a severe acute respiratory syndrome, a characteristic hyperinflammatory response, vascular damage, microangiopathy, angiogenesis and widespread thrombosis. Four stages of COVID-19 have been identified: the first stage is characterised by upper respiratory tract infection; the second by the onset of dyspnoea and pneumonia; the third by a worsening clinical scenario dominated by a cytokine storm and the consequent hyperinflammatory state; and the fourth by death or recovery. Currently, no treatment can act specifically against the SARS-CoV-2 infection. Based on the pathological features and different clinical phases of COVID-19, particularly in patients with moderate to severe COVID-19, the classes of drugs used are antiviral agents, inflammation inhibitors/antirheumatic drugs, low molecular weight heparins, plasma, and hyperimmune immunoglobulins. During this emergency period of the COVID-19 outbreak, clinical researchers are using and testing a variety of possible treatments. Based on these premises, this review aims to discuss the most updated pharmacological treatments to effectively act against the SARS-CoV-2 infection and support researchers and clinicians in relation to any current and future developments in curing COVID-19 patients.

Keywords: Antirheumatic drugs; Antiviral agents; COVID-19; Inflammation inhibitors; Low molecular weight heparins; SARS-CoV-2.

Fig. 1

A proposed potential therapeutic algorithm based on current studies and clinical trials § In the early stages of COVID-19, one or a combination of antiviral agents could be used as a prophylactic or early treatment option to decrease viral load, transmission and prevent progression to the later stage of the disease. The early treatment is under evaluation in some clinical trials (U. S. National Library of Medicine. ClinicalTrial.gov, 2020a; U. S. National Library of Medicine. ClinicalTrial.gov, 2020b) *In the early stage, specific adjustment of glucocorticoid therapy could be needed based on specific reasons (i.e. in adrenal insufficient patients (Isidori et al., 2000)). WHO suggests not to use corticosteroids in the treatment of patients with non-severe COVID-19 as the treatment brought no benefits (World Health Organization, 2020 b).** Based on the clinical status, anticoagulants could be administered to prevent thrombotic phenomena starting from the pulmonary circulation as a consequence of hyperinflammation. Several studies showed that inflammatory cytokines (Il-1, IL-6), c-reactive proteins (CPR), fibrinogen, D-Dimer, ferritin and other biomarkers are significantly elevated in patients with more advanced disease. Therefore, specific immunomodulators and corticosteroids are useful to counteract and prevent the cytokine storm and anticoagulants to prevent thrombotic events. The antiviral remdesivir appears to shorten recovery times for hospitalised patients.