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Review
. 2021;23(12):28.
doi: 10.1007/s11908-021-00769-8. Epub 2021 Dec 11.

Therapeutic Options for Coronavirus Disease 2019 (COVID-19): Where Are We Now?

Esther Y Golnabi  1 , James M Sanders  1 , Meagan L Johns  1 , Kevin Lin  2 , Jessica K Ortwine  3 , Wenjing Wei  3 , Norman S Mang  3 , James B Cutrell  4
Affiliations
Review

Therapeutic Options for Coronavirus Disease 2019 (COVID-19): Where Are We Now?

Esther Y Golnabi et al. Curr Infect Dis Rep. 2021.

Abstract

Purpose of review: Rapidly evolving treatment paradigms of coronavirus disease 2019 (COVID-19) introduce challenges for clinicians to keep up with the pace of published literature and to critically appraise the voluminous data produced. This review summarizes the clinical evidence from key studies examining the place of therapy of recommended drugs and management strategies for COVID-19.

Recent findings: The global magnitude and duration of the pandemic have resulted in a flurry of interventional treatment trials evaluating both novel and repurposed drugs targeting various aspects of the viral life cycle. Additionally, clinical observations have documented various stages or phases of COVID-19 and underscored the importance of timing for the efficacy of studied therapies. Since the start of the COVID-19 pandemic, many observational, retrospective, and randomized controlled studies have been conducted to guide management of COVID-19 using drug therapies and other management strategies. Large, randomized, or adaptive platform trials have proven the most informative to guide recommended treatments to-date. Antimicrobial stewardship programs can play a pivotal role in ensuring appropriate use of COVID-19 therapies based on evolving clinical data and limiting unnecessary antibiotics given low rates of co-infection.

Summary: Given the rapidly evolving medical literature and treatment paradigms, it is recommended to reference continuously updated, curated guidelines from national and international sources. While the drugs and management strategies mentioned in this review represent the current state of recommendations, many therapies are still under investigation to further define optimal COVID-19 treatment.

Supplementary information: The online version contains supplementary material available at 10.1007/s11908-021-00769-8.

Keywords: Anticoagulation; Antimicrobial stewardship; Antivirals; COVID-19; Immunomodulators; SARS-CoV-2.

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Conflict of interest statement

Esther Golnabi, James Sanders, Meagan Johns, Kevin Lin, Jessica Ortwine, Wenjing Wei, and Norman Mang declare that they have no conflict of interest. James Cutrell reports non-financial support from the NIH, Gilead, and Regeneron from COVID-19 treatment trials outside of this work.

Figures

Fig. 1
Fig. 1
Clinical management approach to COVID-19 based on disease phase and severity. Clinical observations from patients with COVID-19 have identified various disease phases from the pre-exposure period through a viral symptom and inflammatory phase and ending with a recovery phase. Early phases are marked by symptoms attributable to viral replication whereas later phases appear to be driven more by host inflammatory and immune responses in addition to a hypercoagulable state. Determination of the disease phase and severity of a patient may inform timing of specific COVID-19 therapies to maximize their efficacy and minimize toxicity. CP convalescent plasma, mAb monoclonal antibody therapy (against SARS-CoV-2), PASC post-acute sequelae of COVID-19. Adapted from: Gandhi RT, Lynch JB, Del Rio C. Mild or Moderate Covid-19. N Engl J Med. 2020;383(18):1757–66. doi:10.1056/NEJMcp2009249. By permission of Massachusetts Medical Society. Copyright © 2021.
See this image and copyright information in PMC

References

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    1. Sanders JM, Monogue ML, Jodlowski TZ, Cutrell JB. Pharmacologic Treatments for Coronavirus Disease 2019 (COVID-19): A Review. JAMA. 2020;323(18):1824–1836. doi: 10.1001/jama.2020.6019. - DOI - PubMed
    1. • COVID-19 Treatment Guidelines Panel. Coronavirus Disease 2019 (COVID-19) Treatment Guidelines. National Institutes of Health. 2021. https://www.covid19treatmentguidelines.nih.gov/. Accessed 20 September 2021. The guidelines for the management of coronavirus disease 2019 developed by the US National Institutes of Health (NIH) that continue to be updated with newly emerging clinical data.
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    1. Gandhi RT, Lynch JB, Del Rio C. Mild or moderate Covid-19. N Engl J Med. 2020;383(18):1757–1766. doi: 10.1056/NEJMcp2009249. - DOI - PubMed