Covid-19 Drugs

In late 2019 a severe outbreak of acute respiratory illness was first identified in Wuhan, China and was shown to be due to a novel coronavirus, the Severe Acute Respiratory Syndrome associated Coronavirus-2 (SARS-CoV-2). The infection rapidly spread globally, causing severe morbidity and mortality worldwide. Within a year of its recognition as a global pandemic, more than 100 million persons had been infected with SARS-CoV-2 and more than 2 million had died of the resulting pneumonia and systemic illness, referred to has COVID-19. Antiviral therapies as well as immunomodulatory treatments evolved quickly, and preventive approaches were attempted, including use of convalescent serum, immune globulins, and monoclonal antibodies. Most importantly, innovative vaccines were developed, several of which have been granted emergency use authorization (EUA) in the United States and abroad. Hepatotoxicity has not been a major problem with most agents used in therapy of COVID-19, but instances of acute liver injury have been reported. Confounding the situation, it is also clear that patients with severe COVID-19 often have liver test abnormalities and some may have significant liver injury seemingly caused by the acute coronavirus infection itself. The therapy of COVID-19 includes oral and parenterally administered agents, antiviral drugs, immunomodulatory medications, anticytokines, monoclonal antibodies and miscellaneous agents. Many of the agents are conventional medications, initially approved for other medical conditions and repurposed to treat COVID-19. Prevention of COVID-19 was initially attempted using public health measures, as well as pre- and post-exposure antiviral therapies but was ultimately more reliably achieved by vaccination. Vaccines effective in preventing COVID-19 were developed rapidly and approved for use by the FDA in the United States under emergency use authorization. Use of convalescent plasma, immune globulins and monoclonal antibodies have also been assessed as means of prevention with promising but only partial efficacy. Most recently, specific, direct-acting antiviral agents have been developed with potent activity against SARS-CoV-2 in vitro and in vivo. These agents were found to be effective if administered soon after onset of infection, most reliably if given with 5 days of onset of symptoms or first identification of infection. Hepatotoxicity is rare with most medications used to treat COVID-19, but can occur. Most medications are given for a short time only, and the symptoms and signs of the SARS-CoV-2 infection overshadow the mild and transient liver injury that arises with some of the medications used to treat or manage COVID-19. Furthermore, instances of acute hepatitis and bile duct injury and loss have been reported in patients with severe COVID-19 in which medications did not appear to play a role.