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Pharmacotherapy in COVID-19; A narrative review for emergency providers.
Am J Emerg Med. 2020 07; 38(7):1488-1493.AJ

Abstract

INTRODUCTION

The COVID-19 pandemic has been particularly challenging due to a lack of established therapies and treatment guidelines. With the rapid transmission of disease, even the off-label use of available therapies has been impeded by limited availability. Several antivirals, antimalarials, and biologics are being considered for treatment at this time. The purpose of this literature review is to synthesize the available information regarding treatment options for COVID-19 and serve as a resource for health care professionals.

OBJECTIVES

This narrative review was conducted to summarize the effectiveness of current therapy options for COVID-19 and address the controversial use of non-steroidal anti-inflammatory drugs (NSAIDs), angiotensin converting enzyme (ACE) inhibitors, and angiotensin receptor blockers (ARBs). PubMed and SCOPUS were queried using a combination of the keywords "COVID 19," "SARS-CoV-2," and "treatment." All types of studies were evaluated including systematic reviews, case-studies, and clinical guidelines.

DISCUSSION

There are currently no therapeutic drugs available that are directly active against SARS-CoV-2; however, several antivirals (remdesivir, favipiravir) and antimalarials (chloroquine, hydroxychloroquine) have emerged as potential therapies. Current guidelines recommend combination treatment with hydroxychloroquine/azithromycin or chloroquine, if hydroxychloroquine is unavailable, in patients with moderate disease, although these recommendations are based on limited evidence. Remdesivir and convalescent plasma may be considered in critical patients with respiratory failure; however, access to these therapies may be limited. Interleukin-6 (IL-6) antagonists may be used in patients who develop evidence of cytokine release syndrome (CRS). Corticosteroids should be avoided unless there is evidence of refractory septic shock, acute respiratory distress syndrome (ARDS), or another compelling indication for their use. ACE inhibitors and ARBs should not be discontinued at this time and ibuprofen may be used for fever.

CONCLUSION

There are several ongoing clinical trials that are testing the efficacy of single and combination treatments with the drugs mentioned in this review and new agents are under development. Until the results of these trials become available, we must use the best available evidence for the prevention and treatment of COVID-19. Additionally, we can learn from the experiences of healthcare providers around the world to combat this pandemic.

Authors+Show Affiliations

Emergency Medicine Department, George Washington University School of Medicine and Health Sciences, Washington, DC, USA.Emergency Medicine Department, MedStar Washington Hospital Center, Washington, DC, USA.Emergency Medicine Department, George Washington University School of Medicine and Health Sciences, Washington, DC, USA.Emergency Medicine Department, George Washington University School of Medicine and Health Sciences, Washington, DC, USA. Electronic address: pourmand@gwu.edu.

Pub Type(s)

Journal Article
Review

Language

eng

PubMed ID

32336586

Citation

Mehta, Nikita, et al. "Pharmacotherapy in COVID-19; a Narrative Review for Emergency Providers." The American Journal of Emergency Medicine, vol. 38, no. 7, 2020, pp. 1488-1493.
Mehta N, Mazer-Amirshahi M, Alkindi N, et al. Pharmacotherapy in COVID-19; A narrative review for emergency providers. Am J Emerg Med. 2020;38(7):1488-1493.
Mehta, N., Mazer-Amirshahi, M., Alkindi, N., & Pourmand, A. (2020). Pharmacotherapy in COVID-19; A narrative review for emergency providers. The American Journal of Emergency Medicine, 38(7), 1488-1493. https://doi.org/10.1016/j.ajem.2020.04.035
Mehta N, et al. Pharmacotherapy in COVID-19; a Narrative Review for Emergency Providers. Am J Emerg Med. 2020;38(7):1488-1493. PubMed PMID: 32336586.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Pharmacotherapy in COVID-19; A narrative review for emergency providers. AU - Mehta,Nikita, AU - Mazer-Amirshahi,Maryann, AU - Alkindi,Nour, AU - Pourmand,Ali, Y1 - 2020/04/15/ PY - 2020/04/01/received PY - 2020/04/12/revised PY - 2020/04/13/accepted PY - 2020/4/28/pubmed PY - 2020/7/17/medline PY - 2020/4/28/entrez KW - COVID 19 KW - Favipiravir KW - Hydroxychloroquine KW - Remdesivir KW - SARS-CoV-2 SP - 1488 EP - 1493 JF - The American journal of emergency medicine JO - Am J Emerg Med VL - 38 IS - 7 N2 - INTRODUCTION: The COVID-19 pandemic has been particularly challenging due to a lack of established therapies and treatment guidelines. With the rapid transmission of disease, even the off-label use of available therapies has been impeded by limited availability. Several antivirals, antimalarials, and biologics are being considered for treatment at this time. The purpose of this literature review is to synthesize the available information regarding treatment options for COVID-19 and serve as a resource for health care professionals. OBJECTIVES: This narrative review was conducted to summarize the effectiveness of current therapy options for COVID-19 and address the controversial use of non-steroidal anti-inflammatory drugs (NSAIDs), angiotensin converting enzyme (ACE) inhibitors, and angiotensin receptor blockers (ARBs). PubMed and SCOPUS were queried using a combination of the keywords "COVID 19," "SARS-CoV-2," and "treatment." All types of studies were evaluated including systematic reviews, case-studies, and clinical guidelines. DISCUSSION: There are currently no therapeutic drugs available that are directly active against SARS-CoV-2; however, several antivirals (remdesivir, favipiravir) and antimalarials (chloroquine, hydroxychloroquine) have emerged as potential therapies. Current guidelines recommend combination treatment with hydroxychloroquine/azithromycin or chloroquine, if hydroxychloroquine is unavailable, in patients with moderate disease, although these recommendations are based on limited evidence. Remdesivir and convalescent plasma may be considered in critical patients with respiratory failure; however, access to these therapies may be limited. Interleukin-6 (IL-6) antagonists may be used in patients who develop evidence of cytokine release syndrome (CRS). Corticosteroids should be avoided unless there is evidence of refractory septic shock, acute respiratory distress syndrome (ARDS), or another compelling indication for their use. ACE inhibitors and ARBs should not be discontinued at this time and ibuprofen may be used for fever. CONCLUSION: There are several ongoing clinical trials that are testing the efficacy of single and combination treatments with the drugs mentioned in this review and new agents are under development. Until the results of these trials become available, we must use the best available evidence for the prevention and treatment of COVID-19. Additionally, we can learn from the experiences of healthcare providers around the world to combat this pandemic. SN - 1532-8171 UR - https://www.unboundmedicine.com/medline/citation/32336586/Pharmacotherapy_in_COVID_19 L2 - https://linkinghub.elsevier.com/retrieve/pii/S0735-6757(20)30263-1 DB - PRIME DP - Unbound Medicine ER -