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Potential Treatments for COVID-19

With the recent worldwide COVID-19 outbreak, healthcare professionals, researchers, and scientists are working to find out which medicines may help slow the spread of the novel coronavirus, and treat and prevent the disease.

Coronavirus refers to a group of viruses that cause breathing problems like the common cold, Severe Acute Respiratory Syndrome (SARS), and Middle East Respiratory Syndrome (MERS). COVID-19 is the disease caused by this previously unknown, or novel, coronavirus.

Currently there are no medicines approved by the Food and Drug Administration (FDA) for the treatment of COVID-19. However, there are several possible options being to see if already approved medicines can be used to treat coronavirus and to see if new medicines will work to treat or prevent COVID-19. Additionally, the FDA has given emergency approval for doctors to prescribe chloroquine, hydroxychloroquine, and remdesivir for the treatment of COVID-19.

Researchers are also working to create a vaccine that would prevent COVID-19, but it may take at least a year or longer before it would be available. Although there aren’t any treatments yet, doctors, pharmacists, and nurses are using medications to treat symptoms associated with COVID-19, particularly those patients who are hospitalized and in intensive care units.

Potential Medications for COVID-19
Listed below are some of the medications that researchers are looking at as possible treatments for COVID-19:

  • Chloroquine (Aralen)
    • How is it used?
      • Chloroquine is approved by the FDA to treat malaria. It is also used to treat lupus and rheumatoid arthritis.
    • What is the evidence for using this medication to treat COVID-19?
      • There is limited information right now. Several clinical trials are in process using various dosages in people with COVID-19 in China and other countries.
      • In lab experiments, chloroquine has been shown to keep COVID-19 from infecting cells.  It may also reduce inflammation in people with viral infections.
    • Summary
      • More information is needed to know how well chloroquine works to treat COVID-19. While there are reports that chloroquine can keep the virus from spreading throughout your body and shorten the time you feel sick, there also are concerns about side effects and potential drug interactions that may occur.
      • The FDA has approved an Emergency Use Authorization (EUA) to allow chloroquine to treat adults and adolescents who weigh at least 110 pounds and who are hospitalized with COVID-19, but who are unable to participate in a clinical study.
      • Chloroquine should be used only in hospitalized patients or in those enrolled in a clinical study, under the direction of a doctor.
      • Chloroquine can cause an irregular heartbeat and therefore should be used with caution in people with at risk for irregular heartbeat and in those taking certain medications (e.g., azithromycin) that increase this risk.
      • If you are taking chloroquine, before sure to tell your doctor if you have side effects or report these events to FDA MedWatch.
      • Do not take chloroquine that is intended for veterinary use – such as to treat fish in aquariums or for use in other animals—to treat or prevent COVID-19. The FDA reports that serious injury and death have been reported in people misusing these preparations.

 

  • Hydroxychloroquine (Plaquenil)
    • How is it used?
      • Hydroxychloroquine is used to treat malaria, lupus, and rheumatoid arthritis.
    • What is the evidence for using this medication to treat COVID-19?
      • Several clinical studies are in progress using various dosages of hydroxychloroquine in people with COVID-19 in China and other countries.
      • In lab experiments, hydroxychloroquine has shown to keep viruses including COVID-19 from spreading throughout the body.  It may also reduce inflammation in people with viral infections.
      • Some lab studies suggest that it may be more potent than chloroquine, but results are conflicting and additional research is needed.
      • Results from COVID-19 patients who have been treated with hydroxychloroquine are being put together and reviewed. These studies include reports of possible clinical benefits, including a decrease in the amount of virus in the body and length of illness. There is only limited data available right now to support how well this works in people with COVID-19.
  • Hydroxychloroquine with Azithromycin
    • What is the evidence for using these medications to treat COVID-19?
      • Preliminary data from an ongoing study in France of hospitalized patients with COVID-19 was used to see how well hydroxychloroquine worked when used alone or with azithromycin (Zithromax) compared to untreated patients based on the amount of COVID-19 virus found in nose and throat samples. Results showed that all of the patients in the hydroxychloroquine and azithromycin group tested negative for the virus after about a week, compared to a little more than half of patients in the hydroxychloroquine group, and less than a quarter of the untreated group. This was a very small study and did not include information about the severity of the cases, how the disease developed, and what the final outcome was.
    • Summary
      • Much like chloroquine, more information is needed to know how well hydroxychloroquine, either alone or in combination with azithromycin, works to treat COVID-19. While there are reports that hydroxychloroquine can keep the virus from spreading throughout your body and shorten the time you feel sick, there also are concerns about side effects and potential drug interactions that may occur.
      • The FDA has approved an EAU to allow hydroxychloroquine to treat adults and adolescents who weigh at least 110 pounds and who are hospitalized with COVID-19, but who are unable to participate in a clinical study.
      • Hydroxychloroquine should be used only in hospitalized patients or in those enrolled in a clinical study, under the direction of a doctor.
      • Chloroquine can cause an irregular heartbeat and therefore should be used with caution in people with at risk for irregular heartbeat and in those taking certain medications (e.g., azithromycin) that increase this risk.
      • If you are taking chloroquine, before sure to tell your doctor if you have side effects or report these events to FDA MedWatch.

 

  • Lopinavir and Ritonavir (Kaletra)
    • How are they used?
      • Lopinavir and ritonavir are used along with other medications to treat human immunodeficiency virus (HIV) infection.
      • This medication combination appeared to help patients during the SARS and MERS outbreaks.
    • What is the evidence for using these medications to treat COVID-19?
      • Several clinical studies are underway. One study compared the use of lopinavir and ritonavir with standard medical care to medical care alone. The researchers found that while patients did not get better faster in lopinavir and ritonavir group, but the 28-day death rate was less.
      • There is some evidence that taking lopinavir and ritonavir within 12 days after you begin to have symptoms is associated with shorter time to getting well. No significant differences were found to suggest a reduction of the amount of virus in the body, the length of time the virus can be found in the body, the length of time oxygen is needed, the amount of time hospitalized, or the length of time from starting treatment until death occurred. In this study, lopinavir and ritonavir treatment was stopped early in 13 people because of adverse effects to the medication.
      • Another study looked back at the use of lopinavir and ritonavir with or without Arbidol (an antiviral medicine for influenza that is not licensed in United States). After a week of treatment, more patients in the lopinavir and ritonavir with Arbidol group tested negative for the virus. After two weeks, nearly all of the patients in the lopinavir and ritonavir with Arbidol group tested negative for the virus.
      • Additional clinical studies have begun that will compare the use of lopinavir and ritonavir to hydroxychloroquine in patients with mild cases. Studies will also look at the use of lopinavir and ritonavir with other antiviral medicines, such as ribavirin and interferon β-1B, (Betaseron, Extavia) compared to lopinavir and ritonavir alone.
    • Summary
      • The use of lopinavir and ritonavir for the treatment of COVID-19 has not yet been established. Additional research is needed to understand the benefits of starting lopinavir and ritonavir early. Researchers are also looking at how lopinavir and ritonavir can be combined with other antiviral medicines for better results. Some scientists are hopeful because this strategy has been used to treat other similar viral infections.

 

  • Remdesivir
    • How is it used?
      • It is a broad-spectrum antiviral medicine that was first developed to treat Ebola, and later found to be somewhat effective against SARS and MERS. It has also been shown to be effective against coronaviruses.
    • What is the evidence for using this medication to treat COVID-19?
      • There is some evidence that remdesivir is effective against COVID-19. Lab experiments and animals studies with viruses similar to COVID-19 have noted activity against the viruses when given before infection and have provided benefits when given after the animal was already infected.
      • Gilead Pharmaceuticals, remdesivir’s manufacturer, is conducting two clinical studies, one to evaluate safety and antiviral activity of remdesivir in people with severe COVID-19 and the other in patients with moderate cases.
      • The National Institutes of Health trial (NIAID ACTT-1) reports that people receiving intravenous (into a vein) remdesivir for COVID-19, had a shorter time (11 days) to recovery than those that did not get the medication (15 days).
      • Other clinical trials are also underway in the United States, China, and other countries.
    • Summary
      • Remdesivir is currently the most promising antiviral medication being investigated for the treatment of COVID-19. However, more information is needed to know how well and how safely remdesivir works.
      • The FDA has approved an Emergency Use Authorization (EUA) to allow adults and children who are hospitalized with severe COVID-19 to receive remdesivir.

     

  • Azithromycin (Zithromax)
    • How is it used?
      • Azithromycin is an antibiotic used to treat common bacterial infections like ear infections, lung infections, or skin infections.
    • What is the evidence for using this medication to treat COVID-19?
      • There are mixed reports of effectiveness when azithromycin was used along with other medications to treat viral infections of the respiratory tract. However, there is some evidence that azithromycin help improve the immune system and reduce inflammation when used in patients with some viral infections such as influenza.
      • Azithromycin has been used to treat bacterial infections in hospitalized patients with COVID-19.
      • Azithromycin has also been used along with hydroxychloroquine in patients with COVID-19. A small study of 6 patients found after about a week of treatment with azithromycin and hydroxychloroquine, all 6 patients were found to have negative test results for the virus. This is a small study and these results may not represent possible clinical effects for patients with COVID-19.
    • Summary
      • There is not enough information currently to fully detail the pros and cons of using of azithromycin along with other medications in the management of COVID-19. More information is needed before any conclusions can be made regarding possible benefits of using a combination of hydroxychloroquine and azithromycin in patients with COVID-19.

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