En español | As the world eagerly awaits the distribution of coronavirus vaccines, researchers and agencies like the National Institutes of Health (NIH) continue to evaluate potential COVID-19 treatments, including the use of antiviral drugs, corticosteroids and antibody therapies.
So far, the U.S. Food and Drug Administration (FDA) has approved just one treatment — the antiviral drug remdesivir — for patients hospitalized with COVID-19. Other treatments, such as Regeneron's monoclonal antibody cocktail, have been granted emergency use authorizations (EUA) by the agency, which allow them to be used while more research is gathered on their efficacy and effects.
Advancements in our understanding of COVID-19 have also improved treatment outcomes. “We know so much more now than we did in March or April,” says Gopi Patel, M.D., associate professor of infectious diseases in the department of medicine at the Mount Sinai Hospital in New York City.
Two main processes are now thought to drive the progression of the disease: First, the virus replicates in lung cells, causing respiratory symptoms and others, like fever. This is followed in some patients by an exaggerated immune response leading to tissue damage and severe complications including septic shock and multi-organ failure.
Based on this understanding, experts believe that antiviral therapies likely have the greatest effect early in the course of disease, while immunosuppressive/anti-inflammatory therapies are likely to be more beneficial in the later stages of COVID-19.
The following list of drugs and therapies currently being used to treat COVID-19 will be updated as new developments occur.
The first and only drug approved for use in hospitalized patients with COVID-19, remdesivir (brand name Veklury) received FDA approval on Oct. 22. An antiviral, remdesivir works by stopping replication of the SARS-CoV-2 virus and has been studied in several clinical trials, including an NIH-sponsored double-blind trial. That study found that the drug reduced recovery time in patients with severe COVID-19, with benefits most apparent in patients who only required supplemental oxygen (as opposed to more invasive forms of respiratory support, like ventilation).
On Nov. 19, the FDA also granted access to the arthritis medicine baricitinib in combination with remdesivir after studies showed that, when given together, the two drugs helped speed up recovery time in patients requiring oxygen. Baricitinib is not authorized or approved as a stand-alone treatment for COVID-19.
Dexamethasone and other corticosteroids
The World Health Organization (WHO) on Sept. 2 issued new guidelines that strongly recommend the use of dexamethasone (along with other inexpensive and common corticosteroids such as hydrocortisone) for the treatment of patients “with severe and critical COVID-19” after an analysis of several different clinical trials found that corticosteroids cut the risk of death in patients hospitalized with the disease.
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Corticosteroids (often called steroids) like dexamethasone work by reducing inflammation, thereby possibly preventing or mitigating outcomes like lung injury and life-threatening organ dysfunction in severe cases of COVID-19. The use of dexamethasone and other corticosteroids is not recommended for patients with mild symptoms of the disease.
Eli Lilly's bamlanivimab, a monoclonal antibody, received an EUA on Nov. 9 to treat mild to moderate cases of COVID-19 in non-hospitalized patients at high risk of severe disease, including people 65 and older and those with chronic medical conditions. Initial clinical trials have shown bamlanivimab to be effective in reducing COVID-19-related hospitalizations and emergency room visits among this group.
Monoclonal antibodies like bamlanivimab are lab-made proteins designed to mimic the immune system's response to infection, in this case by blocking the coronavirus from attaching to and entering cells. Bamlanivimab is not approved to treat hospitalized patients or those who require oxygen.
Casirivimab and imdevimab
Another antibody treatment, Regeneron's COVID-19 monoclonal antibody cocktail (a combination of the monoclonal antibodies casirivimab and imdevimab) received an EUA on Nov. 21 for the treatment of mild to moderate COVID-19 in people who are at high risk of progressing to more severe illness, including people 65 and older and those with chronic medical conditions.
In a clinical trial of patients with COVID-19, the two drugs were shown to reduce COVID-19-related hospitalizations and emergency room visits when administered together. Casirivimab and imdevimab are not approved to treat hospitalized patients or those who require oxygen.
Convalescent plasma, or blood plasma donated by individuals who have recovered from coronavirus infection, may contain antibodies that speed recovery when administered to patients hospitalized with COVID-19.
The FDA granted an EUA for convalescent plasma on Aug. 23 and more than 70,000 patients have received the therapy as part of a Mayo Clinic-led program that grants access to convalescent plasma outside of a clinical trial setting. The NIH cautions, however, that additional data from randomized clinical trials is needed in order to evaluate convalescent plasma's safety and efficacy.
Cheryl Platzman Weinstock and Rachel Nania contributed reporting.