Table 1.
Indication of use and mechanism of action of principal SARS-CoV-2 medications in Italy
| SARS-CoV-2 infection phase | Medication | Indication | Mechanism of action | AIFA authorization |
|---|---|---|---|---|
|
Phase I and II Viral growth containment |
Darunavir/cobicistat Lopinavir/ritonavir |
HIV treatment | Inhibition of viral replication by the binding and inactivation of the 3CLpro and PL2pro proteases | Off-label use restricted to RCTs (last update July 17th, 2020) |
|
Hydroxychloroquine Chloroquine |
Antimalarials, antirheumatics | Increasing of endosomal pH crucial for virus-cell fusion | Off-label use restricted to RCTs (last update July 22nd, 2020) | |
| Remdesivir* | Ebola virus | In vitro and in vivo activity against SARS-CoV-2, MERS-CoV and SARS-CoV | Compassionate use | |
| Ribavirin* | Chronic HCV and RSV infections | Guanosine analogue that interferes with the replication of RNA and DNA viruses | Compassionate use | |
|
Phase III Inflammation and coagulation control |
Azithromycin | Antibacterial for systemic use | Downregulation of adhesion molecules of cell surface, reduction of pro-inflammatory cytokines production | Authorised out of RCTs only in SARS-CoV-2 positive adult patients with bacterial infections (last update May 5th, 2020) |
| Canakinumab* | Arthritis, autoinflammatory fever, Still’s disease (IL-1 β antibody) | Reduction of SARS-CoV-2-induced pneumonia and inflammation | Compassionate use | |
| Enoxaparin | Prophylaxis of venous thromboembolism | Containment of thrombotic phenomena from the pulmonary circulation | Off-label use | |
| Tocilizumab | RA (IL-6 receptor antibody) | Reduction of SARS-CoV-2-induced pneumonia and inflammation | Off-label use | |
| Ruxolitinib* | Myelofibrosis (inhibitor of JAK1 and JAK2 kinases) | Reduction of SARS-CoV-2-induced pneumonia and inflammation | Compassionate use | |
| Solnatide* | Pseudo-hypoaldosteronism 1B | In study to treat pulmonary permeability oedema in Austria and Germany | Compassionate use |
AIFA Italian Medicines Agency, CoV coronavirus, HCV hepatitis virus C, HIV Human Immunodeficiency Viruses, MERS Middle East Respiratory Syndrome, RA rheumatoid arthritis, RCT randomised clinical trial, RSV respiratory syncytial virus, SARS severe acute respiratory syndrome
*Compassionate use