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COVID-19:潜在治疗方法的综述(皮质类固醇、瑞德西韦、托珠单抗、巴尼韦单抗/依特司韦单抗和卡瑞利珠单抗/替雷利珠单抗)及药理学考虑。

COVID-19: A Review of Potential Treatments (Corticosteroids, Remdesivir, Tocilizumab, Bamlanivimab/Etesevimab, and Casirivimab/Imdevimab) and Pharmacological Considerations.

机构信息

Correct Rx Pharmacy Services, Hanover, MD, USA.

Department of Pharmacy, 42884Valley Baptist Medical Center, Brownsville, TX, USA.

出版信息

J Pharm Pract. 2023 Apr;36(2):407-417. doi: 10.1177/08971900211048139. Epub 2021 Oct 1.

Abstract

: In light of the ongoing global pandemic, this paper reviews data on a number of potential and approved agents for COVID-19 disease management, including corticosteroids, remdesivir, tocilizumab, and monoclonal antibody combinations. Dose considerations, potential drug-drug interactions, and access issues are discussed. : Remdesivir is the first antiviral agent approved for the treatment of COVID-19, based on results from large clinical trials showing reduction in recovery time, faster clinical improvement, and decrease in time to discharge with remdesivir. Dexamethasone and tocilizumab have demonstrated mortality benefits in large, randomized controlled trials. Consequently, the use of corticosteroids has become the standard of care for hospitalized patients with severe or critical COVID-19, while tocilizumab is recommended for use in combination with a corticosteroid in certain hospitalized patients. Recently, monoclonal antibody combinations bamlanivimab/etesevimab and casirivimab/imdevimab received emergency use authorizations for use in non-hospitalized patients with mild-to-moderate COVID-19 at high risk of disease progression. : As data from large clinical trials emerge, the paradigm of COVID-19 treatments has shifted significantly. The use of corticosteroids, remdesivir, and tocilizumab depend on disease severity. Emerging data on monoclonal antibody combinations are promising, but further data are required. Pharmacists can play a role in ensuring appropriate access, correct administration, and safe use of COVID-19 treatments and are encouraged to stay abreast of new developments.

摘要

鉴于当前全球大流行的情况,本文回顾了一些用于 COVID-19 疾病管理的潜在和已批准药物的数据,包括皮质类固醇、瑞德西韦、托珠单抗和单克隆抗体联合用药。本文讨论了剂量注意事项、潜在的药物相互作用和药物可及性问题。瑞德西韦是第一种基于大型临床试验结果获批用于治疗 COVID-19 的抗病毒药物,这些试验表明瑞德西韦能缩短康复时间、更快地改善临床症状并缩短出院时间。地塞米松和托珠单抗在大型随机对照试验中显示出了降低死亡率的效果。因此,皮质类固醇的使用已成为治疗住院的重症或危重症 COVID-19 患者的标准治疗方法,而托珠单抗被推荐与皮质类固醇联合用于某些住院患者。最近,bamlanivimab/etesevimab 和 casirivimab/imdevimab 这两种单克隆抗体联合用药获得了紧急使用授权,可用于有进展为重症 COVID-19 高风险的轻度至中度 COVID-19 非住院患者。随着大型临床试验数据的出现,COVID-19 治疗方法的模式发生了重大转变。皮质类固醇、瑞德西韦和托珠单抗的使用取决于疾病的严重程度。关于单克隆抗体联合用药的数据令人鼓舞,但还需要更多的数据。药剂师可以在确保 COVID-19 治疗药物的合理获得、正确使用和安全使用方面发挥作用,并鼓励他们及时了解新的进展。

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