Recent advances in management of COVID-19: A review

https://doi.org/10.1016/j.biopha.2021.112107Get rights and content
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Highlights

  • SARS-CoV-19 can be targeted at several stages throughout its life cycle.

  • Viral entry can be inhibited by Nanobodies, Monoclonal antibodies, Camostat mesylate, Ivermectin, Baricitinib or SSRI.

  • Viral replication can be inhibited by Plitidespsin, Boceprevir, PF-07304814, Famotidine, Ivermectin and Remdesivir.

  • Anti-inflammatory and antioxidants that prevent cell damage are Melatonin, Baricitinib, Tocilizumab and Fluoxetine.

Abstract

The coronavirus disease 2019 (COVID-19) pandemic caused and is still causing significant mortality and economic consequences all over the globe. As of today, there are three U.S Food and Drug administration (FDA) approved vaccines, Pfizer-BioNTech, Moderna and Janssen COVID-19 vaccine. Also, the antiviral drug remdesivir and two combinations of monoclonal antibodies are authorized for Emergency use (EUA) in certain patients. Furthermore, baricitinib was approved in Japan (April 23, 2021). Despite available vaccines and EUA, pharmacological therapy for the prevention and treatment of COVID-19 is still highly required. There are several ongoing clinical trials investigating the efficacy of clinically available drugs in treating COVID-19. In this study, selected novel pharmacological agents for the possible treatment of COVID-19 will be discussed. Point of discussion will cover mechanism of action, supporting evidence for safety and efficacy and reached stage in development. Drugs were classified into three classes according to the phase of viral life cycle they target. Phase I, the early infective phase, relies on supportive care and symptomatic treatment as needed. In phase II, the pulmonary phase, treatment aims at inhibiting viral entry or replication. Drugs used during this phase are famotidine, monoclonal antibodies, nanobodies, ivermectin, remdesivir, camostat mesylate and other antiviral agents. Finally, phase III, the hyper-inflammatory phase, tocilizumab, dexamethasone, selective serotonin reuptake inhibitors (SSRI), and melatonin are used. The aim of this study is to summarize current findings and suggest gaps in knowledge that can influence future COVID-19 treatment study design.

Abbreviations

ADE
Antibody dependant enhancement of the disease
ARDS
Acute Respiratory Distress Syndrome
CDC
Centers for Disease Control and prevention
CoV
Coronavirus
COVID-19
Coronavirus disease-2019
CVT
Cerebral Venous Thrombosis
EC50
half maximum neutralization concentration
EUA
Emergency Use Authorization
FDA
Food and Drug Administration
IC50
Half maximal inhibitory concentration
IC90
Concentration that inhibits 90% of the virions
ICU
Intensive care unit
IL-6
Interleukin 6
IMP
Importin
IRE1
Inositol-requiring enzyme
1KD
Equilibrium dissociation constant (binding affinity)
LPS
Lipopolysaccharides
MERS
Middle East Respiratory Syndrome
Nbs
Nanobodies
NEJM
The New England Journal of Medicine
NIH
National Institutes of Health
NOS
Reactive nitrogen species
OTC
Over the Counter medication
PCR
Polymerase chain reaction
RBD
Receptor binding domain
RdRp
RNA-dependent RNA polymerase
ROS
Reactive oxygen species
S1R
Sigma 1 receptor
SARS
Severe Acute Respiratory Syndrome
SARS-CoV-2
Severe acute respiratory syndrome corona virus 2
sdNbs
Single domain nanobodies
SPR
Surface plasmon resonance
TMPRSS2
Transmembrane serine protease 2
TNF-alpha
Tumor Necrosis Factor alpha
WHO
World Health Organization

Keywords

COVID-19
SARS-CoV-2
Ivermectin
Famotidine
Nanobodies
Monoclonal antibodies
Remdesivir
SSRI
Fluvoxamine
Dexamethasone
Serotonin
Fluoxetine
Tocilizumab
Melatonin

Cited by (0)

1

Equal contribution

2

ORCID: 000-0002-7046-8587