Current Research Data on Drug Therapy for Novel Coronavirus Associated Disease (COVID-19): Systematic Review
The Center for Healthcare Quality Assessment and Control of the Ministry of Health of the Russian Federation conducted the analysis of clinical studies of drugs used for COVID-19 prevention and treatment and to identify ongoing randomized controlled trials (RCT) of drugs used for COVID-19 prevention and treatment.
The spread of the coronavirus disease 2019 (COVID-19) began in the end of December in China and it keeps spreading across the world. It was caused by a new type of coronavirus SARS-CoV‑2. In March 2020, the World Health Organization (WHO) declared the COVID-19 outbreak a pandemic. As of April 7, 2020, the largest number of infected with coronavirus was registered in the USA: 338, 811 cases; the highest death rate was in Italy: 16, 525 deaths. At that time there were
1, 279, 722 confirmed cases with coronavirus and 72, 614 deaths registered around the world. By the beginning of April, there was already sufficient clinical evidence of this disease in adults and children, how it progresses in pregnant women and infants; risk factors of being infected, severe symptoms and fatal outcome were defined; diagnostic methods were developed; procedures to control the spread of the virus were implemented. However, etiotropic therapy (casual treatment) and prevention of COVID-19 that would be proved efficient is still absent.
Among areas of assessment and development of new drugs for COVID-19 prevention and treatment there are several key ones such as immunotropic drugs including vaccine, medications that show antiviral activity against COVID-19 and those that are used to treat complications caused by coronavirus (e.g., pneumonia). Drugs can be divided into two groups according to the way the virus is exposed to them. First group of drugs inhibit virus’s protein preventing its from entering a cell or replicating it inside a human host. That is how exactly remdesivir works. It is a medication that is currently being tested as a treatment for COVID-19. The disadvantage of this approach is that with time virus particles mutate and change. Coronavirus might evolve in the future and develop resistance to such medications as remdesivir.
Remdesivir (GS‑5734) is a new potential drug, developed in the USA (not registered in the Russian Federation), for viruses treatment, including coronavirus. The medication inhibits virus replication through a premature termination of RNA transcription.
Another alternative is considered to be a blocking mechanism for interaction between viral and human proteins. This approach has more advantages than “turning off” the virus itself because a cell is relatively less sensitive. In this case even if the virus mutates it will not affect the drug.
A purpose of the search of medications for COVID-19 treatment is to test existing antiviral drugs. Among them there are several main drugs that are used to treat influenza (Favipiravir), HIV (Lopinavir/Ritonavir), hepatitis (Ribavirin), Ebola virus disease and Marburg virus (Ramdesivir). Apart from these, a number of antimicrobial drugs to treat malaria is considered (Chloroquine and Hidroxicloroquina, Mefloquine). Monoclonal antibodies and corticosteroids are considered as a therapy for critically ill patients with COVID-19. Moreover, vaccine is being actively developed and tested.
Nevertheless, clinical evidence regarding any vaccine efficacy for COVID-19 prevention does not exist at the moment. According to WHO, 44 vaccines are being developed now, which potentially might be used for immunization against coronavirus. There is information that vaccine designers in China and Australia began testing coronavirus vaccine in people. Also, there was news in media sources that Russian company “Vector” is ready to begin testing of its own vaccine.
As a result of the performed analysis of publications it can be concluded that currently there are no drugs that could confidently be recommended to use them for treatment of patients with COVID-19 for the reason that there is not enough reliable evidence. Available clinical evidence only suggests efficacy or inefficacy of those drugs since most of the available results of clinical trials are contradictory. Nevertheless, a considerable amount of randomized clinical trials will be completed in the nearest future, results of which would identify with greater certainty beneficial therapy methods for patients with COVID-19.