Table 2.
Status of Therapeutic Options and Ongoing Clinical Trials for Specific Antiviral Agents for Treatment of Coronavirus Disease 2019
| Therapeutic | Possible Mechanism of Action | Evidence for Anti-Coronavirus Activity | Evidence for Anti- Severe Acute Respiratory Syndrome Coronavirus 2 Activity | Additional Considerations | Current Status |
|---|---|---|---|---|---|
| Remdesivir | Prodrug of an adenosine analog that leads to impairment of viral replication via delayed chain termination [96] | In vitro, remdesivir demonstrates inhibitory activity against multiple human coronavirus strains [97–100] In a MERS-CoV mouse model, remdesivir improved lung function, decreased pulmonary viral loads, and decreased lung pathology compared with untreated mice [99, 100] In a MERS-CoV nonhuman primate model, remdesivir treatment decreased clinical disease scores, decreased pulmonary viral loads, and decreased lung pathology compared with untreated controls [101] |
Inhibition of viral replication demonstrated in vitro [102] Significantly shortened recovery time in a randomized controlled trial of hospitalized adults [95] |
Limited data on pediatric use from Ebola treatment trials and individual case reports of pediatric use [103, 104] | Recent FDA emergency use authorization for hospitalized adult and pediatric patients who require oxygen, mechanical ventilation, or extracorporeal membrane oxygenation Phase 2/3 pediatric trial enrolling (NCT04431453) |
| Corticosteroids | Generalized antiinflammatory activity | Widely used among critically ill patients with severe acute respiratory syndrome and Middle East respiratory syndrome | Rates of acute respiratory distress syndrome, shock, and need for respiratory support were higher in patients on steroids, but steroids were only used for those with more severe illness; unclear if there was benefit [105] Dexamethasone reduced deaths by one-third in adults who required mechanical ventilation and by one-fifth in adults who received supplemental oxygen [106] |
Limited pediatric data | Currently available for use for multiple conditions |
| Convalescent plasma | Human convalescent plasma is available from people who have recovered and can donate high-titer neutralizing immunoglobulin-containing plasma | Antiviral activity may result from passive transfer of antibodies, promoting viral clearance | In a randomized trial of 103 patients, convalescent plasma did not provide statistically significant improvement. Trial ended early and may have been underpowered [107] | Available for children via a national expanded access protocol (https://www.uscovidplasma.org) | Multiple trials in progress |
| Chloroquine/ Hydroxychloroquine +/– azithromycin |
Altered glycosylation of the angiotensin-converting enzyme 2 receptor [102, 108] Decreased viral entry due to impaired acidification of endosome [108, 109] Modulation of the host immune response |
In vitro, chloroquine inhibits viral replication of multiple coronavirus strains, although the effect may be lost if the drug is added several hours post-infection [108, 110–113] Hydroxychloroquine inhibits severe acute respiratory syndrome coronavirus and MERS-CoV in vitro [114, 115] |
A large observational study showed neither overall benefit nor harm [116] | FDA warns against use in unmonitored settings due to the potential for arrhythmias, especially with QT prolonging medications | Currently available for use in treating malaria and rheumatologic disorders Currently recommended to be administered only as part of a clinical trial due to lack of efficacy against severe acute respiratory syndrome coronavirus 2 in studies to date [117] |
Updated 10 July 2020.
Abbreviations: FDA, US Food and Drug Administration; MERS-CoV, Middle East respiratory syndrome coronavirus.