Medications to Treat or Prevent Severe COVID-19 Cases

Published: February 15, 2021
Barbara Young
By Barbara Young, PharmD

For those people who develop a COVID-19 infection, recent studies indicate that certain medications may reduce the severity of the illness, time to recovery, or death rate when given in addition to standard hospital care treatments.

Are there medications to stop a mild to moderate COVID infection from becoming severe in people at risk?
Monoclonal antibodies such as the combination of casirivimab and imdevimab, bamlanivimab, and the combination of bamlanivimab and etesevimab are used to treat COVID-19 in people who have certain medical conditions such as diabetes, immunosuppressive conditions, or kidney, heart, or lung disease that put them at higher risk for developing severe COVID-19 symptoms and/or needing to be hospitalized from COVID-19. These medications work by blocking the action of a certain natural substance in the body to stop the spread of the virus.
These medications have not undergone the standard review to be approved by the FDA for use. However, the FDA has approved an Emergency Use Authorization (EUA) to allow use in certain non-hospitalized adults and children 12 years of age and older who weigh at least 88 pounds (40 kg) and who have mild to moderate COVID-19 symptoms.Monoclonal antibodies must be given as a one-time dose as soon as possible after a positive test for COVID-19 and within 10 days after the start of COVID-19 infection symptoms such as a fever, cough, or shortness of breath.

Are there medications to treat severe illness associated with COVID-19?
For those people who develop severe illness due to COVID-19, recent studies have found that certain medications such as remdesivir and dexamethasone may improve outcomes when given in addition to standard hospital care treatments.

Remdesivir is an investigational antiviral medication that has not undergone the standard review for approval by the Food and Drug Administration (FDA). But based on the evidence from certain clinical studies, the FDA has granted an Emergency Use Authorization (EUA) to allow adults and children hospitalized with severe COVID-19 to receive remdesivir.

The National Institutes of Health COVID-19 Treatment Guidelines also recommend remdesivir in hospitalized patients with severe COVID-19. A clinical study found that remdesivir reduced the time to recovery by 4 days in severely ill hospitalized COVID-19 patients who received the drug intravenously for 5 to 10 days along with standard care treatments, compared with similar patients receiving only standard care.

However, other studies in people with moderate or severe COVID-19 treated with remdesivir have not noted significant improvements in outcomes. Additional studies are testing remdesivir and certain other medications to see if they reduce the severity or length of the illness or prevent deaths from the disease.

Dexamethasone is an FDA-approved corticosteroid medication that has been used for treatment in other serious respiratory virus infections. It has anti-inflammatory and other properties to reduce lung damage, which may help improve serious aspects of COVID-19.
A United Kingdom study of hospitalized COVID-19 patients assessed a low dose of dexamethasone given orally or intravenously along with standard care for up to 10 days. Preliminary information suggests that among patients receiving mechanical ventilation, dexamethasone treatment reduced the death rate by nearly one third, compared with patients who did not receive dexamethasone. In patients receiving oxygen (but not mechanical ventilation), the death rate was reduced by 20% in those given dexamethasone. The study also found that hospitalized patients receiving dexamethasone who did not require oxygen or mechanical ventilation did not have a difference in recovery compared to those receiving standard care.

Experts state that corticosteroids such as dexamethasone should not be used for early or mild COVID-19 and should be used only in hospitalized patients requiring intensive care.
It is important to know, however, that patients with COVID-19 who already take corticosteroids for another reason (such as asthma or rheumatoid conditions) should continue to take their prescribed therapy as directed by their doctor.

Researchers are continuing to study the most effective treatments for COVID-19, and the evidence is rapidly changing. However, the best strategy to avoid becoming infected, especially for those at risk for serious illness and for those who may live with high-risk individuals, is to receive a COVID-19 vaccine.

In addition to vaccination, in may also be helpful to limit your interactions with other people as much as possible and to take precautions such as wearing a mask, adhering to physical distancing guidelines, and washing your hands frequently to prevent illness when you interact with others.

Note: The information contained in this article is emerging and rapidly evolving because of ongoing research. Talk to your pharmacist or other healthcare provider if you have any questions about your medications, COVID-19, or other health issues.

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