Hello, I hope you are all doing well. In this edition of Ron’s Clinical Corner, I thought it would be beneficial to review a few new medications being studied for the treatment of COVID-19. I will also give some information on those medications previously studied and the current recommendations.
Currently there are two antiviral medications undergoing clinical trials to assess their safety and efficacy for treating COVID-19. The first is molnupiravir, which had been developed to treat a condition known as Middle East Respiratory Syndrome (MERS) and the other, favipiravir, is used in Japan for the treatment of influenza. Both are selective inhibitors of viral RdRp (RNA-dependent RNA polymerase) which is responsible for the replication of the virus. Preliminary data is available for both of these candidates, with more expected towards the late summer/early fall. There is also the possibility of an emergency use authorization (EUA) by the FDA later this year if study results are promising.
On the other hand, there have been many medications that are approved for use in treating other conditions, that failed to show benefit in the treatment of COVID-19. The table below provides a summary of such medications and current National Institute of Health (NIH) guidelines. The table is for reference only as there could be times, based on disease severity or other factors, where a medication above could still be used.
| MEDICATION | NIH GUIDELINES |
|---|---|
| Hydroxychloroquine | Not recommended for treatment or prophylaxis (pre- or post-) of COVID-19 |
| Lopinavir/ritonavir (Kaletra®) | Not recommended for use in the treatment of any patient with COVID-19 |
| Bamlanivimab | EUA was revoked in April 2021 due to treatment failures associated with increased viral resistance |
| Sarilumab (Kevzara®) | Not recommended for patients either outside the ICU or in ICU but without ventilator or high-flow oxygen |
| Siltuximab (Sylvant®) | Not recommended for use in the treatment of COVID-19 |
| Convalescent plasma | Only recommend high-tier plasma in certain hospitalized patients |
| ntravenous immunoglobulin (IVIG) | Not recommended due to poorly designed studies that have not demonstrated benefit |
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