Table 1.
Therapeutic options for the management of COVID-19 and associated diseases
| Drug name | Type (delivery route) | Use | Eligible patients | Resistance likelihooda | Status |
|---|---|---|---|---|---|
| RdRp inhibitors | |||||
| Remdesivir (Veklury) | Small molecule (i.v.) | Tx | Outpatientsb ≤7 days of symptom onset, or inpatients | Low | Approved by the FDA, EUA in many countries |
| Molnupiravir (Lagevrio) | Small molecule (oral) | Tx | Outpatientsb ≥18 years old and ≤5 days of symptom onset | Low | Approved in the UK, EUA in many countries |
| JT001 (VV116) | Small molecule (oral) | Tx | Outpatientsb ≤5 days of symptom onset | Low | Approved in Uzbekistan |
| Mpro inhibitors | |||||
| Nirmatrelvir–ritonavir (Paxlovid) | Small molecule (oral) | Tx | Outpatientsb ≤5 days of symptom onset | Low | Approved in the UK and EU; EUA in many countries |
| Ensitrelvir (Xocova) | Small molecule (oral) | Tx | Outpatientsb ≤5 days of symptom onset | Low | EUA in Japan, phase III |
| Inhibitors that block the spike–ACE2 interaction | |||||
| Bebtelovimab | mAb (i.v.) | Tx | Outpatientsb ≤7 days of symptom onset | High (e.g., BQ.1, BQ.1.1) | EUA by the FDA; paused owing to resistance |
| Regdanvimab (Regkirona) | mAb (i.v.) | Tx | Outpatientsb ≤7 days of symptom onset | High (e.g., Omicron, Gamma, Beta) | EUA in many countries; paused owing to resistance |
| Sotrovimab | mAb (i.v.) | Tx | Outpatientsb ≤7 days of symptom onset | High (e.g., Omicron) | Approved or EUA in many countries; paused owing to resistance |
| Amubarvimab and romlusevimab | mAbs (i.v.) | Tx | Outpatientsb ≤10 days of symptom onset | High (e.g., Omicron)279 | Approved in China; discontinued |
| Bamlanivimab and etesevimab | mAbs (i.v.) | Tx | Outpatientsb ≤10 days of symptom onset | High (e.g., Omicron, beta) | EUA in many countries; paused owing to resistance |
| PEP | Certain individuals at high risk of COVID-19 | ||||
| Casirivimab and imdevimab (REGEN-COV) | mAbs (i.v. or s.c.) | Tx | Outpatientsb ≤10 days of symptom onset | High (e.g., Omicron) | EUA in many countries, paused owing to resistance |
| PEP | Certain individuals at high risk of COVID-19 | ||||
| Cilgavimab and tixagevimab (Evusheld) | mAbs (i.m.) | PrEP | Certain individuals at high risk of COVID-19 | High (e.g., Omicron) | Approved or EUA in many countries, paused owing to resistance |
| Glucocorticoids | |||||
| Dexamethasone | Small molecule (i.v.) | Tx | Inpatients requiring oxygen support | No | Recommended by COVID-19 guidelines |
| Hydrocortisone | Small molecule (i.v.) | Tx | Inpatients requiring oxygen support | No | Recommended by COVID-19 guidelines |
| Janus kinase inhibitors | |||||
| Baricitinib | Small molecule (oral) | Tx | Inpatients requiring oxygen support | No | Recommended by COVID-19 guidelines |
| Tofacitinib | Small molecule (oral) | Tx | Inpatients requiring oxygen support | No | Recommended by COVID-19 guidelines |
| Cytokine antagonists | |||||
| Tocilizumab | Anti-IL-6R mAb (i.v.) | Tx | Inpatients receiving systemic corticosteroids and requiring oxygen support | No | Recommended by COVID-19 guidelines |
| Sarilumab | Anti-IL-6R mAb (s.c.) | Tx | Inpatients receiving systemic corticosteroids and requiring oxygen support | No | Recommended by COVID-19 guidelines |
| Anakinra | IL-1R antagonist (s.c.) | Tx | Inpatients requiring oxygen supportc | No | EUA by the FDA; authorized in the EU |
| Anticoagulants | |||||
| Various drugs (such as low-molecular-weight heparin) | Various (i.v., s.c. or oral) | Tx, TP | Non-ICU inpatients with no pregnancy190 | No | Recommended by COVID-19 guidelines |
| Anti-C5a inhibitors | |||||
| Vilobelimab | mAb (i.v.) | Tx | Hospitalized adults initiated ≤48 hours of oxygen support | No | EUA by the FDA |
ACE2, angiotensin-converting enzyme 2; COVID-19, coronavirus disease 2019; EUA, emergency use authorization; ICU, intensive care unit; IL-6R, interleukin 6 receptor; i.m., intramuscular injection; i.v., intravenous injection; mAb, monoclonal antibody; PEP, post-exposure prophylaxis; PrEP: pre-exposure prophylaxis; RdRp, RNA-dependent RNA polymerase; s.c., subcutaneous injection; TP, thromboprophylaxis; Tx, treatment. aHigh: >10-fold reduction in susceptibility of any SARS-CoV-2 variant. Low: <5-fold reduction in susceptibility. The data were obtained from the drug label. bNonhospitalized patients with mild-to-moderate COVID-19 and at high risk of progression to severe COVID-19, including hospitalization or death (see drug labels). cInpatients with COVID-19 requiring oxygen support who are at risk of progressing to severe respiratory failure and likely to have elevated levels of plasma soluble urokinase plasminogen activator receptor.