Division of Infectious Diseases, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA; email:
Division of Infectious Diseases, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA; email:
Annu Rev Med. 2024 Jan 29;75:145-157. doi: 10.1146/annurev-med-052422-020316. Epub 2023 Sep 18.
The treatment for COVID-19 has evolved rapidly since the start of the pandemic and now consists mainly of antiviral and immunomodulatory agents. Antivirals, such as remdesivir and nirmatrelvir-ritonavir, have proved to be most useful earlier in illness (e.g., as outpatient therapy) and for less severe disease. Immunomodulatory therapies, such as dexamethasone and interleukin-6 or Janus kinase inhibitors, are most useful in severe disease or critical illness. The role of anti-SARS-CoV-2 monoclonal antibodies has diminished because of the emergence of viral variants that are not anticipated to be susceptible to these treatments, and there still is not a consensus on the use of convalescent plasma. COVID-19 has been associated with increased rates of venous thromboembolism, but the role of antithrombotic therapy is limited. Multiple investigational agents continue to be studied, which will alter current treatment paradigms as new data are released.
自疫情开始以来,COVID-19 的治疗方法迅速发展,现在主要包括抗病毒和免疫调节剂。抗病毒药物,如瑞德西韦和奈玛特韦-利托那韦,已被证明在疾病早期(例如,作为门诊治疗)和轻度疾病中最有用。免疫调节剂治疗,如地塞米松和白细胞介素 6 或 Janus 激酶抑制剂,在重症疾病或危重病中最有用。由于出现了预计对这些治疗方法不敏感的病毒变异体,抗 SARS-CoV-2 单克隆抗体的作用已经减弱,而且对于恢复期血浆的使用仍然没有共识。COVID-19 与静脉血栓栓塞发生率增加有关,但抗血栓治疗的作用有限。多种研究药物仍在研究中,随着新数据的发布,这些药物将改变当前的治疗模式。