Medical Director, Ellis Medical Consulting, Massachusetts, USA.
Dis Mon. 2020 Sep;66(9):101058. doi: 10.1016/j.disamonth.2020.101058. Epub 2020 Jul 28.
With the emergence of COVID-19 extensive research began to identify medications, candidate compounds and other therapeutic approaches. The complex virology of COVID-19 may provide multiple potential target points for antiviral therapy, and vaccines; extensive global research is underway to exploit these potential opportunities. The complex pathophysiology, pulmonary and extrapulmonary disease, and immune mediated effects such as cytokine storm, make medical management more challenging than many viral illnesses. Non medication based interventions including hyperbaric oxygen (HBOT), extracorporeal membrane oxygenation (ECMO), aggressive dialysis, and other interventions, all with various degrees of clinical success, and will be discussed in this section. Several antivirals approved for other clinical indications were studied for repurposing against COVID-19, which we highlight, again with varying results. In addition to therapeutics, concern was raised over potential risks associated with ACE inhibitors and ARB use, which is presented. Often the timing of the medication determined its clinical benefit as will be discussed with dexamethasone and other medications. As such, this Therapeutics Review will present prominent and/or promising medications and therapeutic approaches with the caveats that 1. To date, none are FDA approved beyond emergency use authorization (EUA), and 2. Although a comprehensive look at various classes of interventions, it is by no means a complete list of every compound trialed against COVID-19. Recognizing the knowledge basis upon which we treat COVID-19 patients, develop therapeutics, and vaccines continues to evolve as new information is presented, every effort nevertheless has been made to provide as timely information as possible. It is hoped that the information shared can help guide the clinician in terms of potential options to treat this complex group of patients.
随着 COVID-19 的出现,广泛的研究开始确定药物、候选化合物和其他治疗方法。COVID-19 的复杂病毒学可能为抗病毒治疗和疫苗提供多个潜在的靶点;广泛的全球研究正在进行中,以利用这些潜在的机会。复杂的病理生理学、肺部和肺外疾病以及免疫介导的效应,如细胞因子风暴,使医疗管理比许多病毒性疾病更具挑战性。非药物干预措施包括高压氧 (HBOT)、体外膜氧合 (ECMO)、强化透析和其他干预措施,都具有不同程度的临床成功,将在本节中讨论。一些已批准用于其他临床适应症的抗病毒药物被研究用于重新用于治疗 COVID-19,我们将再次强调,结果不尽相同。除了治疗方法外,还对 ACE 抑制剂和 ARB 应用的潜在风险表示关注,这也将在文中介绍。通常情况下,药物的使用时机决定了其临床疗效,我们将讨论地塞米松和其他药物的情况。因此,本治疗综述将介绍突出和/或有前途的药物和治疗方法,但需要注意的是:1. 迄今为止,除了紧急使用授权 (EUA) 之外,没有一种药物获得 FDA 批准;2. 尽管对各种干预措施进行了全面研究,但这绝不是针对 COVID-19 试验的每种化合物的完整列表。认识到我们治疗 COVID-19 患者、开发治疗方法和疫苗的知识基础不断发展,因为新的信息不断出现,因此已尽最大努力提供尽可能及时的信息。希望所分享的信息能帮助临床医生针对这一组复杂患者的潜在治疗方案提供指导。