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CC BY-NC-ND 4.0 · Ann Natl Acad Med Sci 2020; 56(03): 119-125
DOI: 10.1055/s-0040-1713839
Review Article

Review of Clinical Trials in COVID-19: Trying to Solve the Clinicians’ Conundrum

Amita Athavale
1   Department of Pulmonary Medicine and Environmental Pollution Research Centre, Seth GS Medical College and KEM Hospital, Mumbai, India
,
Vijay Khatri
1   Department of Pulmonary Medicine and Environmental Pollution Research Centre, Seth GS Medical College and KEM Hospital, Mumbai, India
,
Tanya Athavale
1   Department of Pulmonary Medicine and Environmental Pollution Research Centre, Seth GS Medical College and KEM Hospital, Mumbai, India
,
Hemant Deshmukh
2   Department of Radiology, Seth GS Medical College and KEM Hospital, Mumbai, India
,
Gita Nataraj
3   Department of Microbiology, Seth GS Medical College and KEM Hospital, Mumbai, India
,
Rahul Bahot
4   Department of Pulmonary Medicine, Seth GS Medical College and KEM Hospital, Mumbai, India
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Abstract

SARS-CoV-2 and the resulting “COVID-19” has escalated into a pandemic and has resulted in significant morbidity and mortality. Currently, there is no approved antiviral treatment available. Few antiviral agents are undergoing clinical trials for their safety and efficacy against COVID-19. With various repurposed drugs under evaluation, treatment approaches range from search for an effective antiviral, immunomodulation and anticoagulation, use of point-of-care ultrasound to novel ventilatory strategies. Newer agents targeting the inflammatory pathway are also under investigation. There are more than 1955 ongoing clinical trials of repurposed and novel agents. Here we review some of the ongoing trials that have published, at least, interim results of treating patients with COVID-19.

Keywords

COVID-19 - Remdesivir - Favipiravir - Lopinavir/Ritonavir - immunomodulators - convalescent plasma


Publication History

Article published online:
23 July 2020

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  • References

  • 1 Jin Y, Yang H, Ji W. et al. Virology, epidemiology, pathogenesis, and control of COVID-19. Viruses 2020; 12 (04) E372
    CrossrefPubMedGoogle Scholar
  • 2 WHO. Modes of Transmission of Virus Causing COVID-19: Implications for IPC Precaution Recommendations. Available at: https://www.who.int/news-room/commentaries/detail/modes-of-transmission-of-virus-causing-covid-19-implications-for-ipc-precaution- recommendations. Accessed May 7, 2020
  • 3 MyGov. COVID-19 Dashboard. Available at: https://www.mygov.in/covid-19. Accessed May 7, 2020
  • 4 Bi Q, Wu Y, Mei S. et al. Epidemiology and transmission of COVID-19 in 391 cases and 1286 of their close contacts in Shenzhen, China: a retrospective cohort study. Lancet Infect Dis 2020; DOI: 10.1016/S1473-3099(20)30287-5.
    CrossrefPubMedGoogle Scholar
  • 5 Lauer SA, Grantz KH, Bi Q. et al. The incubation period of Coronavirus disease 2019 (COVID-19) from publicly reported confirmed cases: estimation and application. Ann Intern Med 2020; 172 (09) 577-582
    CrossrefPubMedGoogle Scholar
  • 6 Kakodkar P, Kaka N, Baig MN. A comprehensive literature review on the clinical presentation, and management of the pandemic Coronavirus disease 2019 (COVID-19). Cureus 2020; 12 (04) e7560
    PubMedGoogle Scholar
  • 7 Vetter P, Vu DL, L’Huillier AG, Schibler M, Kaiser L, Jacquerioz F. Clinical features of covid-19. BMJ 2020; 369: m1470
    CrossrefPubMedGoogle Scholar
  • 8 MOHFW. Revised Guidelines on Clinical Management of COVID –19. Available at:https://www.mohfw.gov.in/pdf/RevisedNationalClinicalManagementGuidelineforCO VID1931032020.pdf. Accessed June 6, 2020
  • 9 Wang Y, Zhang D, Du G. et al. Remdesivir in adults with severe COVID-19: a randomised, double-blind, placebo-controlled, multicentre trial. Lancet 2020; 395 (10236) 1569-1578
    CrossrefPubMedGoogle Scholar
  • 10 Grein J, Ohmagari N, Shin D. et al. Compassionate use of remdesivir for patients with severe Covid-19. N Engl J Med 2020; 382: 2327-2336
    CrossrefPubMedGoogle Scholar
  • 11 Business Wire. Gilead Announces results from phase 3 trial of investigational antiviral remdesivir in patients with severe COVID-19. Available at: https://www.businesswire.com/news/home/20200429005424/en/. Accessed June 6, 2020
  • 12 Cai Q, Yang M, Liu D. et al. Experimental treatment with favipiravir for COVID-19: an open-label control study. Engineering (Beijing) 2020; DOI: 10.1016/j.eng.2020.03.007.
    CrossrefPubMedGoogle Scholar
  • 13 Young BE, Ong SWX, Kalimuddin S. et al. Singapore 2019 Novel Coronavirus Outbreak Research Team. Epidemiologic features and clinical course of patients infected with SARS-CoV-2 in Singapore. JAMA 2020; 323 (15) 1488-1494
    CrossrefPubMedGoogle Scholar
  • 14 Cao B, Wang Y, Wen D. et al. A trial of lopinavir-ritonavir in adults hospitalized with severe Covid-19. N Engl J Med 2020; 382 (19) 1787-1799
    CrossrefPubMedGoogle Scholar
  • 15 Hung IF-N, Lung K-C, Tso EY-K. et al. Triple combination of interferon beta-1b, lopinavir-ritonavir, and ribavirin in the treatment of patients admitted to hospital with COVID-19: an open-label, randomised, phase 2 trial. Lancet 2020; 395 (10238) 1695-1704
    CrossrefPubMedGoogle Scholar
  • 16 Haematology TL. The Lancet Haematology. The resurgence of convalescent plasma therapy. Lancet Haematol 2020; 7 (05) e353
    CrossrefPubMedGoogle Scholar
  • 17 Lim J, Jeon S, Shin HY. et al. Case of the index patient who caused tertiary transmission of COVID-19 Infection in Korea: the application of lopinavir/ritonavir for the treatment of covid-19 infected pneumonia monitored by quantitative RT-PCR. J Korean Med Sci 2020; 35 (06) e79
    PubMedGoogle Scholar
  • 18 Gautret P, Lagier JC, Parola P. et al. Hydroxychloroquine and azithromycin as a treatment of COVID - results of an open - label non - randomized clinical trial. Int J Antimicrob Agents 2020; DOI: 10.1016/j.ijantimicag.2020.105949.
    CrossrefPubMedGoogle Scholar
  • 19 Caly L, Wagstaff KM, Jans DA. Nuclear trafficking of proteins from RNA viruses: potential target for antivirals?. Antiviral Res 2012; 95 (03) 202-206
    CrossrefPubMedGoogle Scholar
  • 20 Caly L, Druce JD, Catton MG, Jans DA, Wagstaff KM. The FDA-approved drug ivermectin inhibits the replication of SARS-CoV-2 in vitro. Antiviral Res 2020; 178: 104787
    CrossrefPubMedGoogle Scholar
  • 21 Tang N, Bai H, Chen X, Gong J, Li D, Sun Z. Anticoagulant treatment is associated with decreased mortality in severe coronavirus disease 2019 patients with coagulopathy. J Thromb Haemost 2020; 18 (05) 1094-1099
    CrossrefPubMedGoogle Scholar
  • 22 Paranjpe I, Fuster V, Lala A. et al. Association of treatment dose anticoagulation with in-hospital survival among hospitalized patients with COVID-19. J Am Coll Cardiol 2020; DOI: 10.1016/j.jacc.2020.05.001.
    CrossrefPubMedGoogle Scholar
  • 23 Coomes EA, Haghbayan H. Interleukin-6 in COVID-19: a systematic review and meta- analysis. medRxiv 2020; DOI: 10.1101/2020.03.30.20048058.
    CrossrefGoogle Scholar
  • 24 Brown BL, McCullough J. Treatment for emerging viruses: convalescent plasma and COVID-19. Transfus Apheresis Sci 2020; 59 (03) 102790
    CrossrefPubMedGoogle Scholar
  • 25 Gattinoni L, Chiumello D, Caironi P. et al. COVID-19 pneumonia: different respiratory treatments for different phenotypes?. Intensive Care Med 2020; DOI: 10.1007/s00134-020-06033-2.
    CrossrefPubMedGoogle Scholar
  • 26 Marini JJ, Gattinoni L. Management of COVID-19 respiratory distress. JAMA 2020; DOI: 10.1001/jama.2020.6825.
    CrossrefPubMedGoogle Scholar
  • 27 Smith MJ, Hayward SA, Innes SM, Miller ASC. Point-of-care lung ultrasound in patients with COVID-19 – a narrative review. Anaesthesia 2020; DOI: 10.1111/anae.15082.
    CrossrefPubMedGoogle Scholar
  • 28 World Health Organisation. “Solidarity” Clinical Trial for COVID-19 Treatments. Available at: https://www.who.int/emergencies/diseases/novel-coronavirus-2019/global- research-on-novel-coronavirus-2019-ncov/solidarity-clinical-trial-for-covid-19- treatments. Published 2020. Accessed May 9, 2020
  • 29 World Health Organisation. 2019 Novel Coronavirus: A Coordinated Global Research Roadmap to Respond to TheD-19 Epidemic. Available at: https://www.who.int/blueprint/priority-diseases/key-action/Roadmap-version- FINAL-for-WEB.pdf?ua=1. Accessed June 6, 2020
  • 30 Gandhi M, Yokoe DS, Havlir DV. Asymptomatic transmission, the Achilles’ heel of current strategies to control Covid-19. N Engl J Med 2020; DOI: 10.1056/NEJMe2009758.
    CrossrefPubMedGoogle Scholar