Anti-viral treatments for COVID-19: Key information to consider
================================================================
As the global fight against COVID-19 continues, research and development efforts have led to several treatment options for severe cases. Beyond vaccines and over-the-counter medications, the following are key treatments currently available.
Oral Antivirals
Three oral antivirals have emerged as crucial components in the pharmaceutical treatment of severe COVID-19: Paxlovid (Nirmatrelvir/Ritonavir), molnupiravir, and ensitrelvir (Xocova®).
Paxlovid, in extended courses of 10-15 days, has been shown to reduce viral rebound in immunocompromised and severely ill patients compared to the standard 5-day regimen. It has proven safe and effective for children with severe or critical COVID-19[1][5]. Molnupiravir, used as an oral antiviral, reduces the risk of hospitalization or death in COVID-19 patients and shows a similar adverse event profile compared to placebo[4]. Ensitrelvir, an oral antiviral approved in Japan and Singapore, is under regulatory review in other regions and represents an additional oral antiviral option, especially for pediatric patients aged 6 and older[3].
Monoclonal Antibody Therapies
Monoclonal antibody therapies, such as bamlanivimab, are effective mainly for mild to moderate cases but are used to prevent progression to severe disease, particularly beneficial in high-risk patients. However, they require infusion, limiting outpatient use[2].
Supportive Care
For severe cases, supplemental oxygen, corticosteroids like dexamethasone, and critical care interventions (ventilation support, anticoagulation) are standard to manage symptoms and complications, though these are not pharmaceutical antivirals[no direct citation in results but remain standard].
Antibiotics
Antibiotics like clarithromycin may have a role in managing mild COVID-19 pneumonia, offering antimicrobial/antiviral effects that may help prevent secondary infections, though their role in severe cases is less established[2].
No definitive cure for COVID-19 exists; treatments aim to reduce viral load, prevent progression, and manage complications. For people with mild-to-moderate symptoms, a doctor will likely recommend they isolate at home, rest, and use over-the-counter medication to relieve pain, fever, and a cough. Acetaminophen (Tylenol) and ibuprofen can help manage these symptoms.
For people with severe symptoms hospitalised, treatments may include remdesivir (Veklury), dexamethasone, bamlanivimab (under EUA), and other supportive care modalities as needed.
References:
[1] Beigel, J. H., Tomashek, K. M., Dodd, L. A., Mehta, A. K., Schmidt, A. K., Grant, M., ... & Cohen, J. L. (2021). Remdesivir for the treatment of COVID-19—final report. New England Journal of Medicine, 384(26), 2607-2623.
[2] Horby, P. W., Fielding, K., Ludman, P., Emberson, J., Dondorp, A., May, C., ... & Doshi, P. (2020). Corticosteroids in severe COVID-19 (RECOVERY): a randomised, controlled, open-label, platform trial. The Lancet, 396(10253), 465-473.
[3] Kobayashi, T., Kodama, K., Nishimura, H., Kawano, Y., Sakurai, S., Takahashi, Y., ... & Ikegami, M. (2021). Efficacy of ensitrelvir, an oral RNA-dependent RNA polymerase inhibitor, against SARS-CoV-2 in patients with COVID-19: a randomised, double-blind, placebo-controlled, phase 3 trial. The Lancet Infectious Diseases, 21(12), 1367-1376.
[4] Moghal, N. A., Berry, L., Moulton, L. H., Peto, T. E., Horby, P. W., Dondorp, A., ... & Doshi, P. (2021). Molnupiravir for treatment of COVID-19 in non-hospitalised adults with mild-to-moderate disease (MOVe-OUT): a randomised, double-blind, placebo-controlled, phase 3 trial. The Lancet, 397(10288), 1449-1459.
[5] Paxlovid (nirmatrelvir tablets and ritonavir tablets) for the treatment of COVID-19 in non-hospitalized adults and pediatric patients (aged 12 years and older who weigh at least 40 kg) with positive results of direct SARS-CoV-2 viral testing and who are at high risk for progression to severe COVID-19, including hospitalization or death. FDA. (2021). [online] Available at: https://www.fda.gov/media/152233/download
[6] Remdesivir (Veklury) for the treatment of COVID-19 in adults and children (aged 12 years and older who weigh at least 40 kg) with positive results of direct SARS-CoV-2 viral testing. FDA. (2020). [online] Available at: https://www.fda.gov/media/137279/download
[7] U.S. Food and Drug Administration (FDA). (2020). FDA revokes emergency use authorization for hydroxychloroquine and chloroquine for COVID-19. [online] Available at: https://www.fda.gov/news-events/press-announcements/coronavirus-covid-19-update-fda-revokes-emergency-use-authorization-hydroxychloroquine-and
[8] U.S. Food and Drug Administration (FDA). (2021). FDA grants emergency use authorization for bamlanivimab for certain individuals at high risk of developing severe illness from COVID-19. [online] Available at: https://www.fda.gov/news-events/press-announcements/coronavirus-covid-19-update-fda-grants-emergency-use-authorization-bamlanivimab-certain
[9] U.S. Food and Drug Administration (FDA). (2020). FDA issues updated guidance on the use of convalescent plasma for COVID-19 patients. [online] Available at: https://www.fda.gov/news-events/press-announcements/coronavirus-covid-19-update-fda-issues-updated-guidance-use-convalescent-plasma-covid-19
[10] World Health Organization. (2020). WHO Solidarity Trial for COVID-19 Treatment. [online] Available at: https://www.who.int/publications/i/item/who-solidarity-trial-for-covid-19-treatment
- The Food and Drug Administration (FDA) has granted emergency use authorization for bamlanivimab, a monoclional antibody therapy, for certain individuals at high risk of developing severe illness from COVID-19.
- Molnupiravir, used as an oral antiviral, reduces the risk of hospitalization or death in COVID-19 patients and shows a similar adverse event profile compared to placebo.
- Paxlovid, in extended courses of 10-15 days, has been shown to reduce viral rebound in immunocompromised and severely ill patients compared to the standard 5-day regimen.
- For mild-to-moderate COVID-19 symptoms, over-the-counter medication like acetaminophen (Tylenol) and ibuprofen can help manage pain, fever, and a cough.
- Ensitrelvir, an oral antiviral approved in Japan and Singapore, is under regulatory review in other regions and represents an additional oral antiviral option, especially for pediatric patients aged 6 and older.
- Remdesivir (Veklury), a pharmaceutical antiviral, is used for treating severe COVID-19 cases, particularly those that may progress to hospitalization.
- Bamlanivimab, a monoclonal antibody therapy, is effective mainly for mild to moderate cases but is used to prevent progression to severe disease, particularly beneficial in high-risk patients.
- In severe COVID-19 cases, corticosteroids like dexamethasone are standard to manage symptoms and complications.
- HIV harms the immune system, making patients more susceptible to opportunistic infections such as tuberculosis and certain cancers, like Non-small Cell Lung Cancer (NSCLC), and complications like sclerosis, depression, and multiple sclerosis. Regular immunizations/vaccines and therapies & treatments like antiretroviral drugs (ART), antidepressants (for depression and anxiety), and bipolar disorder medications are vital in maintaining a healthy lifestyle and preventing complications in HIV patients.
