Table 1.
Therapeutic agent | Mechanism of action | Ongoing trials, n | Associations | Suggested dosage | Route of administration | Principal side effects | Ref. | NCT identifier |
Hydroxychloroquine | Changes the pH of endosomes, prevents viral entry, transport and post-entry replication | 224 | Azithromycin, tocilizumab, lopinavir-ritonavir | 200 mg BID or TID (10 d) | Oral-intravenous | Retinal toxicity, QT prolongation, nausea | [6-10] | NCT04315948 |
Chloroquine | Increases the endosomal pH interfering with the process of virus/cell fusion | 225 | Remdesivir, tocilizumab | 2.5 g (3 d) | Oral-intravenous | Retinal toxicity, QT prolongation, nausea | [11] | NCT04303507 |
Convalescent plasma | Adaptive immunotherapy (neutralizing antibody tiers above 1:640) | 129 | Remdesivir, Interferon-alpha, oseltamivir, antibacterial and antifungal frugal drugs, methylprednisolone | 200 ml single dose | Intravenous | Evanescent facial red spot | [37-41] | NCT04321421 |
Lopinavir/Ritonavir | Inhibition of the HIV protease/inhibition of CitP450-iso3A4 and augmented plasmatic concentration of lopinavir | 67 | Hydroxychloroquine, azithromycin, dexamethasone | 200 mg/50 mg BID | Oral | Gastrointestinal upset, augmented plasmatic concentration of colchicine | [25-28] | NCT02735707 |
And HGAM-CoA reductase inhibitors | ||||||||
Azithromycin | Prophylaxis of bacterial super-infection | 59 | Hydroxychloroquine, tocilizumab, atovaquone | 500 mg | Oral-intravenous | QT prolongation | [19-24] | NCT04332107 |
Tocilizumab | Monoclonal antibody which targets the IL-6 receptor | 50 | lopinavir-ritonavir, remdesivir, chloroquine, hydroxychloroquine | Dosing according to weight range | Intravenous | Runny or stuffy nose, sinus pain, sore throat, headache, gastrointestinal upset, urinary tract infection | [30] | NCT04320615 |
Ivermectin | Suppression of SARS-CoV-2 viral replication in cell cultures (in vitro) | 30 | Hydroxychloroquine | 600 mcg/kg | Oral | Tiredness, loss of energy, stomach pain, loss of appetite, nausea, vomiting, diarrhea, dizziness | [48] | NCT04381884 |
Dutasteride | ||||||||
Azithromycin | ||||||||
Proxalutamide | ||||||||
Statin | Reduces chemokine release, adhesion molecules, and modulating T cell activity | 23 | Standard of care; colchicine + rosuvastatin | 20 mg/d atorvastatin Rosuvastatin 40 mg/d or equivalent | Oral | rabdomiolisis | [12] | NCT04472611 |
Remdesivir | Nucleotide analogue that is incorporated into the nascent viral RNA chain resulting in its premature termination | 20 | Hydroxychloroquine, chloroquine, tocilizumab, convalescent plasma | 200 mg 1st day – 100 mg (10 d) | Intravenous | Phlebitis, constipation, headache, ecchymosis, nausea, pain in extremities | [13-18] | NCT04292899 |
Methylprednisolone | Immunosuppression against cytokine storm | 17 | Siltuximab, tacrolimus | 40 mg BID (5 d) - f 1-2 mg/kg/d (5-7 d) | Oral-intravenous | Headache, nausea, weight gain, excitement, infections | [35] | NCT04323592 |
Sarilumab | Monoclonal antibody which targets the IL-6 receptor | 17 | Not available | 400 mg or 200mg single dose | Intravenous | Neutropenia, increased ALT, injection site redness, upper respiratory infections, nasal congestion, sore throat, urinary tract infections, thrombocytopenia | [29] | NCT04315298 |
Colchicine | Non-selective inhibitor of NLRP3 inflammasome, inhibitor of microtubule polymerization and leukocyte infiltration | 17 | Not available | 0.5 mg per os (BID) for 3 d - then once daily for the last 27 d | Oral-intravenous | Gastrointestinal upset, low blood cells count and rhabdomyolysis | [33-34] | NCT04322682 |
Heparin | Inhibition of Xa factor and thrombin | 15 | Methylprednisolone | Dosed to target activated partial thromboplastin time (aPTT) between 1.5-2.0 times the normal value | Subcutaneous injection | Reduced creatinine clearance | [45] | NCT04485429 |
Anakinra | Monoclonal antibody which targets the IL-1 receptor | 11 | Siltuximab or tocilizumab (single i.v. injection) | 1 injection a day (max 28 d) | Subcutaneous injection | Gastrointestinal upset, headache, joint pain, flu symptoms, redness-bruising-pain in the injection site | [30,31] | NCT04330638 |
Dexamethasone | Immunosuppression against cytokine storm | 10 | Not available | 20 mg/d (5 d) then 10 mg/d (5 d) | Intravenous | Headache, weight gain, excitement, infections | [36] | NCT04325061 |
Enoxaparin | Inhibition of Xa factor and thrombin | 5 | Not available | 4000 UI/d or 100 UI/kg | Subcutaneous injection | Skin irritation in injection site, bleeding, heparin-induced thrombocytopenia, fatigue, fever | [45] | NCT04367831 |
Eculizumab | Monoclonal antibody which targets C5 inhibiting its cleavage in C5a and C5b | 3 | Hydroxychloroquine, lopinavir-ritonavir, ceftriaxone, vitamin C | 3600 mg/wk (8-22 wk) | Intravenous | Fever, headache, nausea and vomiting, body aches, confusion, increased sensitivity to light, stiffness | [32] | NCT04288713 |
Vitamin C | Antioxidant, increases the synthesis of norepinephrine and vasopressin, attenuate increases in cytokine levels | 3 | All mentioned drugs | 12 g/12 h (7 d) or 50 mg/kg/6 h (4 d) | Oral-intravenous | Gastrointestinal upset | [42-44] | NCT04264533 |
In this table are the most utilized and investigated drugs for the treatment of coronavirus disease 2019. It provides the name of the therapeutic agent, mechanism of action, number of ongoing trials, drug association if available, suggested dosage and maximum period of time the drug should be administered, route of administration, principal side effects, a reference on the drug, and an example of randomized clinical trial (RCT) identified by the national clinical trial number. Drugs investigated in less than three RCTs have been excluded. BID: Bis in die; IL-1: Interleukin 1; NCT: National clinical trial; RCT: Randomized clinical trial; SARS-CoV-2: Severe acute respiratory syndrome coronavirus 2; TID: Tris in die.