Table 3.
Treatment Options for COVID-19
| Treatment strategy | Mechanism of action | Effectiveness | Safety in pregnancy |
|---|---|---|---|
| HCQ/chloroquine85 | Reduces inflammatory cytokines86; interferes with ACE2 receptor synthesis.87,88 | Reduction of body temperature recovery time and cough remission, pneumonia recovery, improved CT findings, nasopharyngeal viral clearance.89, 90, 91 | Generally considered safe in pregnancy and frequently used for patients with autoimmune disease.92 Efficacy unproven. Concern for prolonged QTc. |
| HCQ and azithromycin | Reduction of viral replication and IL-6 and IL-8 production.87,93 | Improved nasopharyngeal viral clearance.90 | HCQ: as above. Azithromycin: considered safe.94 |
| Lopinavir/rotinavir | Inhibition of 3-chymotrypsin-like protease.86,95,96 | Reduced mortality.97 | Good safety profile in pregnant patients with HIV.98 |
| Remdesivir | Inhibition of viral RNA-dependent RNA polymerase.99 | Clinical trial still underway. Reduction in duration of hospital stay and mortality.100 | Not yet FDA approved. |
| Anakinra | IL-1 inhibitor. | Clinical trial still underway. | Insufficient data to determine risk in pregnancy.101 |
| Siltuximab | Human-mouse chimeric monoclonal antibody against IL-6. | Improvement in clinical condition in one-third of patients.102 | Insufficient data to determine risk in pregnancy.103 |
| Sarilumab | Recombinant IL-6 receptor monoclonal antibody. | No data yet from randomized clinical trials or observational studies.85 | Insufficient data to determine risk in pregnancy.85 |
| Tocilizumab | Recombinant IL-6 receptor monoclonal antibody. | No data yet from randomized clinical trials or observational studies.85 | Insufficient data to determine risk in pregnancy.85 |
| Interferon | Antiviral cytokines. | No data yet from randomized clinical trials or observational studies.85 | Varying adverse effect profiles in various preparations. |
| Corticosteroid | Anti-inflammatory actions.104 | Reduced mortality in patients with ARDS.105 Faster improvement in patients with severe COVID pneumonia.106 | Considered safe, approved for lung maturation in preterm birth.107 |
| ACE inhibitors or angiotensin receptor blockers | ACE2 receptor is the cell receptor for viral entry for COVID-19 virus.108,109 | No data yet from randomized clinical trials or observational studies85 | Contraindicated in pregnancy.110,111 |
| Convalescent plasma | Convalescent plasma from recently recovered donors targeting COVID-19 virus. | 10 Patients with clinically severe COVID-19 were given 200 mL of convalescent plasma. Increase in oxyhemoglobin saturation by day 3, and improved lymphocyte count as well as CRP levels were noted.Several studies are currently underway.112 | No data on safety in pregnancy. However, specific immunoglobulins as for varicella are used in pregnancy.103 |
ACE = angiotensin-converting enzyme; ARDS, acute respiratory distress syndrome; COVID-19 = coronavirus disease 2019; CRP = C-reactive protein; CT = computed tomography; FDA = Food and Drug Administration; HCQ = hydroxychloroquine; HIV = human immunodeficiency virus; IL = interleukin.