Table I.
Antiviral and antibody-based therapy for COVID-19.
| A, Antiviral therapy | |||||
|---|---|---|---|---|---|
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| Name | Company | Indication | Mechanism of action | Effectiveness | (Refs.) |
| Interferon-α, Interferon-β | Multiple | Viral infection and certain types of malignant tumor | Protects lower airway | No obvious therapeutic effect on hospitalized patients with COVID-19 | (191) |
| Interferon-γ | Eiger Biopharma-ceuticals | Early phase of mild COVID-19 | Protects upper and lower airway continuously, inhibits cytokine storm | Risk reduction of hospitalizations or ER visits, 50% (trial no. NCT04967430)a | |
| Lopinavir | Multiple | HIV-1 infection | Inhibits HIV-1 3CLpro | Lopinavir + ritonavir has no obvious therapeutic effect on hospitalized patients with COVID-19 (trial no.ChiCTR2000029308)a | (89) |
| Ritonavir | Multiple | HIV-1 and HIV-2 infection | Inhibits CYP3A4 activity, decreases metabolism of antiviral agents | ||
| GC-376 | N/A | Feline infectious peritonitis | Inhibits SARS-CoV-2 3CLpro | Potential | (192) |
| PF-07304814, PF-07321332 | Pfizer | COVID-19 | Inhibits SARA-COV-2 3CLpro | Potential | (193) |
| Paxlovid (nirmaterevir + ritonavir) | Pfizer | Patients with mild-to-moderate COVID-19 (adults and children aged >12 years) with high risk of transforming into severe cases | Nirmatrevir inhibits SARS-COV-2 3CLpro, ritonavir serves as an adjuvant | Risk reduction of hospitalization or ER visit, 89% (trial no. NCT04960202)a | (194) |
| Umifenovir (Arbidol) | BHBT | Influenza | Targets interaction between influenza virus S protein and ACE2 of host cells, induces interferon | Potential (trial no. IRCT20180725040596N2)a | (195) |
| GeLactoferrin | N/A | Targets HSPGs, prevents virus attaching to cells. | Potential | (196) | |
| Camostat mesylate | N/A | Acute symptoms of chronic pancreatitis | Inhibits TMPRSS2 and protease, trypsin and matriptase activity | Potential | (197) |
| Remdesivir (GS-5734) | Gilead Sciences, Inc. | Ebola and Marburg virus, patients with mild-to-moderate COVID-19 (adults and young children aged >28 days and weighing ≥3 kg) | Inhibits expression of viral RNA polymerase | Requires verification. (trial no. NCT04257656.)a | (198) |
| Favilavir/Favipiravir (T-705) | FUJIFILM Wako Pure Chemical Corporation | Influenza, RNA virus infection | Inhibits expression of viral RNA polymerase | Requires verification | (199) |
| Molnupiravir (MK-4482/EIDD-2801) | MSD, Ridgeback Biotherapeutics LP | Patients with mild-to-moderate COVID-19 (adults) | Inhibits expression of viral RNA polymerase | Risk reduction of hospitalization or death, 50%, (trial no. NCT04575597)a | (108) |
| Bemnifosbuvir (AT-527) | Roche, Atea Pharmaceuticals | Patients with mild-to-moderate COVID-19 not requiring hospitalization | Inhibits expression of viral RNA polymerase | Requires verification. Did not meet primary clinical endpoint (trial no. NCT04709835) | (109) |
| Merimepodib (VX-497) | N/A | RNA virus infection | Inhibits IMPDH, suppresses replication of RNA virus | Potential | (200) |
| Plitidepsin | PharmaMar | Multiple myeloma | Inhibits eEF1A | Potential | (110) |
| Fluvoxamine | Multiple | Depression, mild COVID-19 | Inhibits selective serotonin reuptake | Requires verification (trial no. NCT04342663)a | (114) |
| Chloroquine, hydroxychloioquine | N/A | Malaria and rheumatoid arthritis | Inhibit TLRs | Potential but with obvious side effects | (96) |
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| B, Antibody-based therapy | |||||
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| |||||
| Name | Company | Indication | Mechanism of action | Effectiveness | (Refs.) |
|
| |||||
| Convalescent plasma | N/A | Patients with COVID-19 with high risk factors, rapid progression or severe or critical COVID-19 | Purified neutralizing antibody agains t SARS-COV-2 obtained from recovered COVID-19 patients | Potential but controversial | (201) |
| Polyclonal antibody | N/A | Transplantation reaction, autoimmune disease | Immunizing animals with antigen containing multiple epitopes stimulates multiple B cell clones to produce antibodies against multiple epitopes | Potential | (202) |
| Miniprotein | N/A | Artificially designed, high affinity binding to RBD of SARS-CoV-2 S protein | Potential | (203) | |
| Nanobody | N/A | Alpaca-derived antibodies, bind to RBD of SARS-CoV-2 S protein, prevent ACE2 binding | Potential | (204) | |
| Tocilizumab (Actemra) | Roche | Rheumatoid arthritis, severe or critically ill patients with COVID-19 | Monoclonal antibody, binds to non-signaling site of IL-6 (CD126) | Effective but controversial (trial no. NCT04356937)a | (205) |
| Sarilumab (Kevazra) | Sanofi S.A., Regeneron Pharmaceuticals, Inc. | Rheumatoid arthritis, severe or critically ill patients with COVID-19 | Monoclonal antibody, targets α subunit of IL-6 receptor complex | Effective but controversial | (132) |
| Sotrovimab (VIR-7831) | GlaxoSmithKline, Vir Biotechnology, Inc. | Patients with mild-to-moderate COVID-19 (age, >12 years) | Monoclonal antibody, binds to highly conserved epitope of SARS-CoV-2 S protein | Potential but controversial (trial no. NCT04545060)a | (206) |
| Bevacizumab (Avastin) | Roche | Metastatic cancer, severe or critically ill patients with COVID-19 | Monoclonal antibody, inhibits VEGF to suppress growth of new blood vessels | Potential | (133) |
| Bamlanivimab (LY-CoV555) + Etesevimab (LY-CoV016/JS016) | Eli Lilly and Company, Top Alliance Biosciences | Patients with mild-to-moderate COVID-19 (age, >12 years) with high risk of severe illness or hospitalization | Monoclonal antibody, binds to RBD of SARS-CoV-2 S protein | Risk reduction of hospitalization or death, 70% (trial no. NCT04427501)a | (207) |
| Regdanvimab (CT-P59) | Celltrion | Patients with mild-to-moderate COVID-19 | Monoclonal antibody, binds to RBD of SARS-CoV-2 S protein | Potential (trial no. NCT04525079, NCT04593641)a | (208) |
| AZD7442 | AstraZeneca plc | Patients with mild-to-moderate COVID-19 | AZD1061 + AZD8895 monoclonal antibodies, binds two sites of SARS-CoV-2 S protein | Risk reduction of symptomatic COVID-19, 77% (trial no. NCT04625725)a; risk reduction of hospitalization or death, 50%, (trial no. NCT04501978)a | (165,209) |
| BRII-196/BRII-198 | 02137.HK | Patients with mild-to-moderate COVID-19 | Monoclonal antibodies, binds two sites of SARS-CoV-2 S protein | Requires verification (trial no. NCT04501978)a | (210) |
| DXP-593/DXP-604 | 688235.SH | Patients with mild-to-moderate COVID-19 | Monoclonal antibodies, binds two sites of SARS-CoV-2 S protein | Potential | (136) |
| REGEN-COV (Ronapreve) | Regeneron Pharmaceuticals, Inc., Roche | Patients with mild-to-moderate COVID-19 | Casirivima B + Imdevimab monoclonal antibodies, binds two sites of SARS-CoV-2 S protein | Risk reduction of symptomatic and asymptomatic COVID-19, 66.4% (NCT04452318)a; risk reduction of hospitalization or death, 70–71% (trial no. NCT04425629)a | (130,211) |
a
Primary endpoint of phase III study. N/A, not applicable; 3CL pro, 3-chymotrypsin-like protease; CYP3A4, recombinant cytochrome P450 3A4; S, spike; ACE2, angiotensin-converting enzyme 2; HSPGs, heparan sulfate proteoglycans; TMPRSS2, transmembrane protease, serine 2; IMPDH, inosine monophosphate dehydrogenase; eEF1A, eukaryotic translation elongation factor 1; TLR, toll-like receptor; B cell, bone-marrow cell; RBD, receptor binding domain; VEGF, vascular endothelial growth factor.