Table 1.
Potential therapeutic agents as repurposed drugs for the treatment of COVID-19.
| Drug (Year of first usage) | Class & Type | Rationale for Use | Target Disease | Dosage in Current Trials | Supportive Evidence | Caveats | References |
|---|---|---|---|---|---|---|---|
| Remdesivir(2014) | Antiviral; Adenosine nucleotide analogue | Acts as an RNA-chain terminator by binding to RNA dependent RNA polymerase (RdRP). | Ebola | 200 mg intravenously (IV) on day 1 followed by 100 mg IV daily for up to 10 days (NCT04292899) | Effective against SARS and MERS in-vitro | Not currently FDA-approved. Can only be obtained via compassionate use. | [34], [35], [36], [37] |
| Lopinavir/Ritonavir (LPV/r)(2000) | Antiviral; Protease inhibitors | HIV type 1 aspartate protease inhibitor with inhibitory activity against SARS-CoV in-vitro. | HIV | 400/100 mg twice daily for 14 days. (NCT04321174) | Effective against SARS-CoV-1 both in vitro and human studies | Current data suggest a limited role in treatment of COVID-19. | [45], [46], [47] |
| Oseltamivir(1999) | Antiviral; Neuraminidase inhibitor | Inhibits viral replication. | Influenza | 75 mg orally twice a day for 5 days (NCT04338698) | No in-vitro activity against SARS-CoV | Has no role in the management of COVID-19 once influenza has been ruled out. No data against SARS. | [50] |
| Favipiravir(2014) | Antiviral; RNA polymerase inhibitor | RNA-dependent RNA polymerase inhibitor. Also involved in blocking viral replication. | Influenza, arenavirus, filovirus | 1600 mg twice daily on day 1, then 600 mg twice daily thereafter for 7 days (NCT04310228) | In vitro activity seen against SARS-CoV-2 | No available data on its efficacy and safety for the treatment of COVID-19 | [34], [52], [53] |
| Ribavirin (1986) | Antiviral; Nucleoside analogue | Inhibits viral RNA synthesis and mRNA capping. | Syncytial virus, viral hemorrhagic fever, | 400 mg twice daily for 14 days (NCT04276688) | No evidence in SARS and MERS | Risks of ADR (hematologic toxicity, teratogenicity & contraindications in pregnancy) outweigh potential clinical benefit. | [34], [50] |
| Camostatmesylate (2006) | Protease inhibitors | Blocks viral maturation and entry to cells. Inhibits TMPRSS2. | Pancreatitis | 2 × 100 mg pills 3 times daily for 5 days (NCT04321096) | Effectively blocked SARS-CoV-2 in lung cells in vitro. Also showed antiviral activity in an animal model for SARS-CoV infection | Limited data available. | [57], [58] |
| Hydroxychloroquine / chloroquine (HCQ/CQ) (1955/1934) | Antimalarial | Block viral entry into cells by inhibiting glycosylation of host receptors, proteolytic processing, and endosomal acidification. | Malaria | Chloroquine: 500 mg twice daily for 10 days Hydroxychloroquine: 400 mg twice daily × 1 day then 200 mg twice daily × 5 days (NCT04345692) |
In vitro activity against SARS-CoV-2 | Paucity of adequate data to validate their use in COVID-19.Concerns of cardiac arrhythmias | [52], [59], [61] |
| Tocilizumab (2005) | Monoclonal Antibody | IL-6 inhibitor. May block cytokine storm in COVID-19 patients. | Rheumatoid arthritis | 8 mg/kg IV (up to a maximum of 800 mg per dose), with an interval of 12 h(NCT04317092) | No data on SARS or MERS. | Limited data to support current use. | [67] |
| Methylpred-nisolone (1957) | Corticosteroids | Potent anti-inflammatory and antifibrotic properties; May prevent “cytokine storm”; reduce pulmonary and systemic inflammation in pneumonia. | Arthritis, psoriasis, etc. | 120 mg/day IV infusion for 3 days (NCT04345445) | No impact on clinical outcomes in SARS | No proven benefit for their use in COVID-19. Risks of ADRs outweigh the benefits | [73], [74] |
This table represents a list of repurposed therapeutic agents that are being used for the treatment of COVID-19, their class, mechanism of action, dosage, original target disease, and evidence supporting their use in COVID-19 patients.