Emergency Medicine Department, George Washington University School of Medicine and Health Sciences, Washington, DC, USA.
Emergency Medicine Department, MedStar Washington Hospital Center, Washington, DC, USA.
Am J Emerg Med. 2020 Jul;38(7):1488-1493. doi: 10.1016/j.ajem.2020.04.035. Epub 2020 Apr 15.
The COVID-19 pandemic has been particularly challenging due to a lack of established therapies and treatment guidelines. With the rapid transmission of disease, even the off-label use of available therapies has been impeded by limited availability. Several antivirals, antimalarials, and biologics are being considered for treatment at this time. The purpose of this literature review is to synthesize the available information regarding treatment options for COVID-19 and serve as a resource for health care professionals.
This narrative review was conducted to summarize the effectiveness of current therapy options for COVID-19 and address the controversial use of non-steroidal anti-inflammatory drugs (NSAIDs), angiotensin converting enzyme (ACE) inhibitors, and angiotensin receptor blockers (ARBs). PubMed and SCOPUS were queried using a combination of the keywords "COVID 19," "SARS-CoV-2," and "treatment." All types of studies were evaluated including systematic reviews, case-studies, and clinical guidelines.
There are currently no therapeutic drugs available that are directly active against SARS-CoV-2; however, several antivirals (remdesivir, favipiravir) and antimalarials (chloroquine, hydroxychloroquine) have emerged as potential therapies. Current guidelines recommend combination treatment with hydroxychloroquine/azithromycin or chloroquine, if hydroxychloroquine is unavailable, in patients with moderate disease, although these recommendations are based on limited evidence. Remdesivir and convalescent plasma may be considered in critical patients with respiratory failure; however, access to these therapies may be limited. Interleukin-6 (IL-6) antagonists may be used in patients who develop evidence of cytokine release syndrome (CRS). Corticosteroids should be avoided unless there is evidence of refractory septic shock, acute respiratory distress syndrome (ARDS), or another compelling indication for their use. ACE inhibitors and ARBs should not be discontinued at this time and ibuprofen may be used for fever.
There are several ongoing clinical trials that are testing the efficacy of single and combination treatments with the drugs mentioned in this review and new agents are under development. Until the results of these trials become available, we must use the best available evidence for the prevention and treatment of COVID-19. Additionally, we can learn from the experiences of healthcare providers around the world to combat this pandemic.
由于缺乏既定的治疗方法和治疗指南，COVID-19 大流行尤其具有挑战性。由于疾病的快速传播，即使是现有疗法的标签外使用也因供应有限而受到阻碍。目前正在考虑使用几种抗病毒药、抗疟药和生物制剂进行治疗。本文综述的目的是综合现有关于 COVID-19 治疗选择的信息，并为医疗保健专业人员提供资源。
本叙述性综述旨在总结当前 COVID-19 治疗选择的有效性，并解决非甾体抗炎药（NSAIDs）、血管紧张素转换酶（ACE）抑制剂和血管紧张素受体阻滞剂（ARB）的争议性使用问题。使用“COVID 19”、“SARS-CoV-2”和“治疗”的关键词组合在 PubMed 和 SCOPUS 上进行了查询。评估了包括系统评价、病例研究和临床指南在内的所有类型的研究。
目前尚无直接针对 SARS-CoV-2 活性的治疗药物；然而，几种抗病毒药（瑞德西韦、法匹拉韦）和抗疟药（氯喹、羟氯喹）已成为潜在的治疗方法。目前的指南建议在中度疾病患者中联合使用羟氯喹/阿奇霉素或氯喹，如果羟氯喹不可用，尽管这些建议基于有限的证据。在有呼吸衰竭风险的重症患者中可以考虑使用瑞德西韦和恢复期血浆；然而，这些疗法的获得可能受到限制。在出现细胞因子释放综合征（CRS）证据的患者中可以使用白细胞介素-6（IL-6）拮抗剂。除非有证据表明难治性感染性休克、急性呼吸窘迫综合征（ARDS）或其他使用的强烈指征，否则不应使用皮质类固醇。此时不应停用 ACE 抑制剂和 ARB，并且可以使用布洛芬退热。
目前正在进行几项临床试验，以测试本文中提到的药物的单一和联合治疗的疗效，并且正在开发新的药物。在这些试验的结果公布之前，我们必须使用预防和治疗 COVID-19 的最佳现有证据。此外，我们可以从世界各地的医疗保健提供者的经验中学习，以应对这一大流行病。
