Klinik für Infektiologie, Westdeutsches Zentrum für Infektiologie, Universitätsmedizin Essen, Universität Duisburg-Essen, Essen, Deutschland.
Institut für Virologie, Universitätsklinikum Essen, Universität Duisburg-Essen, Essen, Deutschland.
Klin Monbl Augenheilkd. 2021 May;238(5):569-578. doi: 10.1055/a-1423-8961. Epub 2021 May 21.
Since the end of 2019, the novel severe acute respiratory syndrome coronavirus type 2 (SARS-CoV-2) has been spreading worldwide and has caused severe health and economic issues on a global scale. By the end of February 2021, more than 100 million SARS-CoV-2 cases had been reported worldwide. SARS-CoV-2 causes the coronavirus disease 2019 (COVID-19) that can be divided into three phases: An early phase with fever and cough (phase I), a pulmonary vascular disease (phase II) and a hyperinflammatory syndrome (phase III). Since viral replication plays a particularly important role in the early stage of the disease and the patient's immune system in the later course of infection, different therapeutic options arise depending on the stage of the disease. The antiviral nucleoside analogue remdesivir is the only antiviral compound with conditional approval in the European Union. Treatment with remdesivir should be initiated early (within the first seven days of symptom onset) in patients receiving supplemental oxygen without invasive ventilation. In turn, the anti-inflammatory corticosteroid dexamethasone should be administered later in the course of disease in patients receiving oxygen therapy. Since autopsies indicate an increased frequency of thromboembolic events due to COVID-19, additional treatment with anticoagulants is recommended. Since the development of novel antivirals may take years, the application of convalescent plasma from patients who recovered from a SARS-CoV-2 infection for the treatment of COVID-19 is reasonable. However, large-scale studies indicated low efficacy of convalescent plasma. Furthermore, vaccination of the population is essential to control the pandemic. Currently, the mRNA vaccine Tozinameran from BioNTech and Pfizer, the mRNA-1273 vaccine from Moderna as well as the vector vaccine AZD1222 from AstraZeneca are licensed in the European Union. All three vaccines have demonstrated high efficacy in large clinical trials. In addition to these licensed vaccines, many others are being tested in clinical trials. In the present article, an overview of therapeutic options for COVID-19 as well as vaccines for protection against SARS-CoV-2 is provided.
自 2019 年底以来，新型严重急性呼吸综合征冠状病毒 2 型（SARS-CoV-2）在全球范围内传播，并在全球范围内造成严重的健康和经济问题。截至 2021 年 2 月底，全球已报告超过 1 亿例 SARS-CoV-2 病例。SARS-CoV-2 导致 2019 年冠状病毒病（COVID-19），可分为三个阶段：发热和咳嗽的早期阶段（I 期）、肺血管疾病（II 期）和高炎症综合征（III 期）。由于病毒复制在疾病早期和感染后期患者的免疫系统中起着特别重要的作用，因此根据疾病阶段出现了不同的治疗选择。抗病毒核苷类似物瑞德西韦是欧盟有条件批准的唯一抗病毒化合物。在接受补充氧气但未进行有创通气的患者中，应在症状出现后的头七天内（早期）开始使用瑞德西韦治疗。反过来，在接受氧气治疗的患者中，应在疾病过程的后期给予抗炎皮质类固醇地塞米松。由于尸检表明 COVID-19 导致血栓栓塞事件的频率增加，因此建议加用抗凝剂治疗。由于新型抗病毒药物的开发可能需要数年时间，因此使用从 SARS-CoV-2 感染中康复的患者的恢复期血浆来治疗 COVID-19 是合理的。但是，大型研究表明恢复期血浆的疗效较低。此外，对人群进行疫苗接种对于控制大流行至关重要。目前，辉瑞/BioNTech 的 Tozinameran mRNA 疫苗、Moderna 的 mRNA-1273 疫苗和阿斯利康的腺病毒载体疫苗 AZD1222 在欧盟获得许可。所有这三种疫苗在大型临床试验中均显示出很高的疗效。除了这些许可疫苗外，还有许多其他疫苗正在临床试验中进行测试。在本文中，提供了 COVID-19 的治疗选择以及针对 SARS-CoV-2 的疫苗保护概述。
