Davis J, Umeh U, Saba R. Treatment of SARS-CoV-2 (COVID-19): A safety perspective. World J Pharmacol 2021; 10(1): 1-32 [DOI: 10.5497/wjp.v10.i1.1]
Corresponding Author of This Article
Joshua Davis, MD, Attending Doctor, Department of Emergency Medicine, Vituity, 929 N. St. Francis Avenue, Wichita, KS 67214, United States. jjvwd@udel.edu
Research Domain of This Article
Pharmacology & Pharmacy
Article-Type of This Article
Review
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
World J Pharmacol. Nov 20, 2021; 10(1): 1-32 Published online Nov 20, 2021. doi: 10.5497/wjp.v10.i1.1
Treatment of SARS-CoV-2 (COVID-19): A safety perspective
Joshua Davis, Ugochukwu Umeh, Rand Saba
Joshua Davis, Department of Emergency Medicine, Vituity, Wichita, KS 67214, United States
Ugochukwu Umeh, College of Medicine, Medical University of Lublin, Lublin 20-093, Poland
Rand Saba, Department of Surgery, Ascension Providence Hospital, Southfield, MI 48075, United States
Author contributions: Davis J devised the concept and drafted the manuscript; All authors contributed to data collection, editing for critical content, and approved and take final responsibility for the final manuscript.
Conflict-of-interest statement: All authors have no conflicts of interest, financial or other, to declare.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Joshua Davis, MD, Attending Doctor, Department of Emergency Medicine, Vituity, 929 N. St. Francis Avenue, Wichita, KS 67214, United States. jjvwd@udel.edu
Received: June 28, 2021 Peer-review started: June 28, 2021 First decision: July 31, 2021 Revised: August 22, 2021 Accepted: September 16, 2021 Article in press: September 16, 2021 Published online: November 20, 2021 Processing time: 141 Days and 21.8 Hours
Abstract
The goal of this review is to report a balanced perspective of current evidence for efficacy of treatments for coronavirus disease 2019 (COVID-19) against the historical safety of these treatments as of May 2021. We preselected therapies of interest for COVID-19 based on national guidelines and modified over time. We searched PubMed and Medline for these specific COVID-19 treatments and data related to their efficacy. We also searched for prior randomized controlled trials of each therapy to assess adverse effects, and we obtained the Food and Drug Administration Approval label for this information. Several drugs have been approved for the treatment of COVID-19, and many more are under study. This includes dexamethasone, remdesivir, hydroxychloroquine/chloroquine, lopinvir/ritonavir, interferon or interleukin inhibitors, convalescent plasma and several vitamins and minerals. The strongest evidence for benefit is mortality benefit with dexamethasone in patients with COVID-19 and hypoxemia, although there is a signal of harm if this is started too early. There are several other promising therapies, like interleukin inhibitors and ivermectin. Hydroxychloroquine/chloroquine, lopinvir/ritonavir, and convalescent plasma do not have enough evidence of benefit to outweigh the known risks of these drugs.
Core tip: Coronavirus disease 2019 (COVID-19) has radically changed the approach to healthcare and public health in the last year. Over 100 million people worldwide have been affected. Dexamethasone appears to be the most efficacious drug for appropriately selected patients with COVID-19 (i.e., those requiring supplemental oxygen). Remdesivir may reduce length of hospitalization with mild side effects. While they do not have enough evidence to be recommended at this time, ivermectin and zinc should be studied further for early illness and interferon and interleukin blockade should be studied for critical illness. Hydroxychloroquine/chloroquine, azithromycin, and vitamins C and D have no evidence of benefit at this time.
