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. 2020 Aug 20;72(6):1446–1478. doi: 10.1007/s43440-020-00152-9

Table 1.

The certain or probable mechanism of actions of pharmacological treatments against COVID-19

Treatment group Drug name Target Mechanism of action Ref
Inhibitors of viral replication Ribavirin RdRp, as nucleoside analog Lethal mutagenesis, Inhibition of nucleotide biosynthesis by inhibiting of viral RNA polymerase [24, 26]
Remdesivir RdRp, as nucleoside analog Acting on viral RNA polymerase [41]
Favipiravir RdRp Inhibition of transcription and replication of viral gene [60]
Emtricitabine/tenofovir Viral reverse transcriptase Viral replication inhibitor [71]
Oseltamivir Viral neuraminidase Viral replication inhibitor [72]
Inhibitors of viral proteases Lopinavir/ritonavir Viral main proteases (e.g., 3CLp, Nsp3c) Blocks the multiplication cycle by inhibiting the viral proteases [87]
Darunavir Viral main proteases (e.g., 3CLp, Nsp3c) Prevents the formation of mature infectious virus particles [11]
Danoprevir Chymotrypsin-like protease Prevents the formation of mature virus particles [114]
Atazanavir Viral protease (e.g., 3CLp), helicase Prevents the formation of mature virus particles [121, 122]
Cobicistat Inhibition of human CYP3A proteins Helps to viral protease inhibitory effects [123, 124]
Noscapine Binds to viral protease Prevents the formation of mature virus particles; anti-oxidant; anti-inflammatory [125, 128]
Inhibitors of viral entry to host cell Baricitinib Janus kinase (JAK) enzymes Prevents viral entry into cells via (a) inhibits AP2-associated protein kinase 1 (AAK1) that promotes endocytosis of the virus, (b) interaction with cyclin G-associated kinase (GAK); anti-inflammatory [153155]
Ruxolitinib Janus kinase (JAK) enzymes Prevents viral entry into cells by inhibiting the viral clathrin-mediated endocytosis [157, 161]
Chloroquine/Hydroxychloroquine The entry of extracellular zinc to intracellular lysosomes Inhibits viral entry; interferes with RdRp function; immunomodulatory effect [49, 130, 131, 133]
Arbidol Viral fusion to host cell surface Inhibits viral entry; probably inhibits viral replication [71, 147]
Recombinant human ACE2 (rhACE2) Spike protein Acts similarly to the ACE2 enzyme; prevent the viral attachment to host cell surface [162]
Bromhexine Trans-membrane protease serine 2 (TMPRSS2) Inhibits viral entry and slows down the rate of virus replication [167, 168]
Immunoenhancement agents Interferon-β Increases the activity of immune system; activation of RNase that breaks down the nucleic acid chain of the virus; blocks the translation of mRNA; prevents encapsidation and viral release [182, 183]
Interferon-α-1b/2b Stimulates innate anti-viral responses [17]
Nivolumab (Programmed cell death blocker) PD-1 as a specific marker on cytotoxic T lymphocytes Blocking immune checkpoint molecules and improves the T cell responses [187, 188]
Levamisole Enhances the cellular immunity; immunostimulatory and immunosuppressive functions [192]
Immunomodulating agents intravenous immunoglobulin (IVIg); convalescent plasma Improves the immunity by immunomodulatory and anti-inflammatory effects [197]
Fingolimod Sphingosine-1 phosphate (S1P) receptors Reduces the lymphocytes egress from lymph nodes; inhibit angiogenesis during inflammation; promotes the endothelial barrier function; regulates the B cells and dendritic cells migration [204, 205]
Thalidomide Suppresses the activation of NF-κB; down-regulation of selected cell surface adhesion molecules Suppression of excessive production of TNF-α; reduces the leukocyte migration [210]
Immunosuppressive and anti-inflammatory agents Corticosteroids (methylprednisolone, ciclesonide) Phospholipase A2 Immunosuppressive activities; anti-inflammatory properties; reduces body temperature [213]
Tocilizumab IL6- receptor Inhibits the IL-6 signal transduction [237]
Sarilumab IL6- receptor Inhibits the IL-6 signal transduction [143]
Siltuximab IL6 Neutralizes IL-6 bioactivity; enhances cytochrome P450 activity; decreases the levels of TNF-α, IL-1, CCL2, CXCL12, and VEGF [288, 289]
NSAIDs (paracetamol, ibuprofen) Cyclooxygenase (COX) enzymes Anti-inflammatory effect by inhibiting of the prostaglandins production; [269]
Eculizumab C5 complement protein Blocking the cleavage of complement protein C5 into C5a and C5b; decreases the inflammation and cell damages [262]
Tetrandrine Anti-inflammatory effect by inhibition of 5-lipoxygenase, IL-5, IL-6 and IL-1; anti-oxidant; anti-fibrogenic; immunomodulation; inhibition of platelet aggregation [267, 268]
Pulmonary vaso-effectors Nitric oxide inhalation Smooth muscle cells in respiratory tract Vasodilator [271]
Sildenafil Type 5 phosphodiesterase Increases the level of cGMP and induces vasodilatory effects [278, 279]
Aviptadil Adenosine cyclase Increases the activity of adenosine cyclase; relaxation of cavernosal smooth muscle [281]
Bevacizumab Vascular endothelial growth factor (VEGF) Prevents the angiogenic activity; decrease vascular permeability and pulmonary edema [282]
Losartan Angiotensin II receptor Inhibition of smooth muscle constriction; anti-fibrotic role in lung injury and protects lung fibrosis [285]
Others Mepolizumab IL-5 Anti-asthma; inhibiting ligand binding and decreasing peripheral blood eosinophils [287]
Carrimycin Mycobacterium tuberculosis Anti-tuberculosis [286]