Treatment of SARS-CoV-2 (COVID-19): A safety perspective

Abstract

The goal of this review is to report a balanced perspective of current evidence for efficacy of treatments for coronavirus disease 2019 (COVID-19) against the historical safety of these treatments as of May 2021. We preselected therapies of interest for COVID-19 based on national guidelines and modified over time. We searched PubMed and Medline for these specific COVID-19 treatments and data related to their efficacy. We also searched for prior randomized controlled trials of each therapy to assess adverse effects, and we obtained the Food and Drug Administration Approval label for this information. Several drugs have been approved for the treatment of COVID-19, and many more are under study. This includes dexamethasone, remdesivir, hydroxychloroquine/chloroquine, lopinvir/ritonavir, interferon or interleukin inhibitors, convalescent plasma and several vitamins and minerals. The strongest evidence for benefit is mortality benefit with dexamethasone in patients with COVID-19 and hypoxemia, although there is a signal of harm if this is started too early. There are several other promising therapies, like interleukin inhibitors and ivermectin. Hydroxychloroquine/chloroquine, lopinvir/ritonavir, and convalescent plasma do not have enough evidence of benefit to outweigh the known risks of these drugs.

Keywords: COVID-19; Coronavirus; SARS-CoV-2; SARS; Drug safety; Pharmacotherapy

Core tip: Coronavirus disease 2019 (COVID-19) has radically changed the approach to healthcare and public health in the last year. Over 100 million people worldwide have been affected. Dexamethasone appears to be the most efficacious drug for appropriately selected patients with COVID-19 (i.e., those requiring supplemental oxygen). Remdesivir may reduce length of hospitalization with mild side effects. While they do not have enough evidence to be recommended at this time, ivermectin and zinc should be studied further for early illness and interferon and interleukin blockade should be studied for critical illness. Hydroxychloroquine/chloroquine, azithromycin, and vitamins C and D have no evidence of benefit at this time.