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COVID-19: Therapeutics and interventions currently under consideration.

ABSTRACT: With the emergence of COVID-19 extensive research began to identify medications, candidate compounds and other therapeutic approaches. The complex virology of COVID-19 may provide multiple potential target points for antiviral therapy, and vaccines; extensive global research is underway to exploit these potential opportunities. The complex pathophysiology, pulmonary and extrapulmonary disease, and immune mediated effects such as cytokine storm, make medical management more challenging than many viral illnesses. Non medication based interventions including hyperbaric oxygen (HBOT), extracorporeal membrane oxygenation (ECMO), aggressive dialysis, and other interventions, all with various degrees of clinical success, and will be discussed in this section. Several antivirals approved for other clinical indications were studied for repurposing against COVID-19, which we highlight, again with varying results. In addition to therapeutics, concern was raised over potential risks associated with ACE inhibitors and ARB use, which is presented. Often the timing of the medication determined its clinical benefit as will be discussed with dexamethasone and other medications. As such, this Therapeutics Review will present prominent and/or promising medications and therapeutic approaches with the caveats that 1. To date, none are FDA approved beyond emergency use authorization (EUA), and 2. Although a comprehensive look at various classes of interventions, it is by no means a complete list of every compound trialed against COVID-19. Recognizing the knowledge basis upon which we treat COVID-19 patients, develop therapeutics, and vaccines continues to evolve as new information is presented, every effort nevertheless has been made to provide as timely information as possible. It is hoped that the information shared can help guide the clinician in terms of potential options to treat this complex group of patients.

SUBMITTER: McFee RB

PROVIDER: S-EPMC7386392 | biostudies-literature | 2020 Sep

REPOSITORIES: biostudies-literature

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COVID-19: Therapeutics and interventions currently under consideration.

McFee R B RB

Disease-a-month : DM 20200728 9

With the emergence of COVID-19 extensive research began to identify medications, candidate compounds and other therapeutic approaches. The complex virology of COVID-19 may provide multiple potential target points for antiviral therapy, and vaccines; extensive global research is underway to exploit these potential opportunities. The complex pathophysiology, pulmonary and extrapulmonary disease, and immune mediated effects such as cytokine storm, make medical management more challenging than many ...[more]

PMID: 32868092

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Project description:BackgroundWhile Molnupiravir and Paxlovid have recently been approved for use in some countries, there are no widely available treatments for COVID-19, the disease caused by SARS-CoV-2 infection. Herbal extracts have been used to treat respiratory clinical indications by Ayurvedic medicine practitioners with minimal adverse reactions and intense research efforts are currently under way to develop some of these formulations for COVID-19 treatment.MethodsLiterature search for in silico, in vitro, in vivo, and clinical studies on the topic of Ayurvedic formulations for potential COVID-19 treatment, in order to present the current state of current knowledge by integrating information across all systems.ResultsThe search yielded 20 peer reviewed articles on in silico studies examining the interaction of phytoconstituents of popular Ayurvedic formulations with SARS-CoV-2 components and its receptors; five articles on preclinical investigations of the ability of selected Ayurvedic formulations to inhibit functions of SARS-CoV-2 proteins; and 51 completed clinical trials on the efficacy of using Ayurvedic formulations for treatment of mild to moderate COVID-19. Clinical data was available from 17 of the 51 trials. There was a considerable overlap between formulations used in the in silico studies and the clinical trials. This finding was unexpected as there is no clearly stated alignment between studies and the traditional pathway to drug discovery- basic discovery leading to in vitro and in vivo proof of concept, followed by validation in clinical trials. This was further demonstrated in the majority of the in silico studies where focus was on potential antiviral mechanisms, while the clinical trials were focused on patient recovery using oral treatments. In all 17 clinical trials where data was available, Ayurvedic treatments lead to a shorter period to recovery in participants with COVID-19.ConclusionThe most commonly used Ayurvedic treatments for management of respiratory symptoms associated with SARS-CoV-2 infection appear to have prophylactic and/or therapeutic properties. It would be of particular interest to assess synergistic and concomitant systemic effects and antiviral activities of individual phytoconstituents and their combinations in the Ayurvedic treatments.

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COVID-19: Therapeutics and interventions currently under consideration.

Publications

COVID-19: Therapeutics and interventions currently under consideration.

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