Department of Pharmacy, University of Texas Southwestern Medical Center, Dallas.
Division of Infectious Diseases and Geographic Medicine, Department of Medicine, University of Texas Southwestern Medical Center, Dallas.
JAMA. 2020 May 12;323(18):1824-1836. doi: 10.1001/jama.2020.6019.
IMPORTANCE: The pandemic of coronavirus disease 2019 (COVID-19) caused by the novel severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) presents an unprecedented challenge to identify effective drugs for prevention and treatment. Given the rapid pace of scientific discovery and clinical data generated by the large number of people rapidly infected by SARS-CoV-2, clinicians need accurate evidence regarding effective medical treatments for this infection. OBSERVATIONS: No proven effective therapies for this virus currently exist. The rapidly expanding knowledge regarding SARS-CoV-2 virology provides a significant number of potential drug targets. The most promising therapy is remdesivir. Remdesivir has potent in vitro activity against SARS-CoV-2, but it is not US Food and Drug Administration approved and currently is being tested in ongoing randomized trials. Oseltamivir has not been shown to have efficacy, and corticosteroids are currently not recommended. Current clinical evidence does not support stopping angiotensin-converting enzyme inhibitors or angiotensin receptor blockers in patients with COVID-19. CONCLUSIONS AND RELEVANCE: The COVID-19 pandemic represents the greatest global public health crisis of this generation and, potentially, since the pandemic influenza outbreak of 1918. The speed and volume of clinical trials launched to investigate potential therapies for COVID-19 highlight both the need and capability to produce high-quality evidence even in the middle of a pandemic. No therapies have been shown effective to date.
重要性:由新型严重急性呼吸系统综合症冠状病毒 2 引起的 2019 年冠状病毒病(COVID-19)大流行对确定有效的预防和治疗药物提出了前所未有的挑战。鉴于 SARS-CoV-2 感染人数众多,科学发现和临床数据的快速发展,临床医生需要有关这种感染的有效医疗治疗的准确证据。
观察结果:目前尚无针对该病毒的有效治疗方法。关于 SARS-CoV-2 病毒学的迅速扩展的知识提供了大量潜在的药物靶点。最有前途的治疗方法是瑞德西韦。瑞德西韦对 SARS-CoV-2 具有很强的体外活性,但尚未获得美国食品和药物管理局批准,目前正在进行的随机试验中进行测试。奥司他韦并未显示出疗效,皮质类固醇目前不推荐使用。目前的临床证据不支持在 COVID-19 患者中停止使用血管紧张素转换酶抑制剂或血管紧张素受体阻滞剂。
结论和相关性:COVID-19 大流行代表了这一代人以及自 1918 年大流行性流感爆发以来最大的全球公共卫生危机。为研究 COVID-19 的潜在治疗方法而启动的临床试验的速度和数量突显了即使在大流行期间也需要并能够产生高质量证据的能力。迄今为止,尚无有效的治疗方法。
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