Treatment of SARS-CoV-2 (COVID-19): A safety perspective

Table 1 Summary of guideline recommendations for COVID-19 treatment

Organization	Dexamethasone	Hydroxychloroquine	Remdesivir	Convalescent plasma	Tocilizumab
World Health Organization	Strong recommendation to use in patients with severe/critical illness; Conditional recommendation against use in non-severe/critical patients	Strong recommendation against use	Conditional recommendation against use	No recommendation	No recommendation
United States Centers for Disease Control and Prevention/National Institutes of Health	Recommend use in patient requiring supplemental oxygen or mechanical ventilation; Recommend against use in patients not requiring supplemental oxygen	Recommend against	Recommend in hospitalized patients requiring supplemental oxygen; Not routinely recommended for patients requiring mechanical ventilation	Recommends against use in hospitalized patients; No recommendation for non-hospitalized or immunocompromised patients	Recommended for patients requiring mechanical ventilation within 24 h of ICU admission
Infectious Disease Society of America	Suggest against use in hospitalized patients not requiring oxygen; Suggest use for patients with severe disease; Recommend use for patients with critical disease	Recommend against use	Suggest against use in hospitalized patients not requiring oxygen; Suggest use for patients with severe/critical disease	Suggest against use	Conditionally suggest use in severe/critical patients
Surviving Sepsis/Society for Critical Care Medicine	Recommend for patients with severe/critical illness	Recommend against use in patients with severe/critical illness	Recommend to use in severe/critical patients not receiving mechanical ventilation; Recommend against starting in patients receiving mechanical ventilation	Recommend against (outside of clinical trial) for patients with severe/critical illness	No recommendation

Table 2 Common adverse reaction of immunomodulators used in treatment of COVID-19

Drug	Class	Adverse effects
Anakinra	Interleukin 1 inhibitor	Abdominal pain; anaphylaxis; elevated liver enzymes; flu-like symptoms; headache; local reactions; nausea/vomiting/diarrhea; neutropenia; sinusitis
Canakinumab	Anti-interleukin 1β monoclonal antibody	Abdominal pain; elevated liver enzymes; flu-like symptoms; hematologic cytopenias; hypersensitivity reactions; local reactions; nausea/vomiting/diarrhea; sinusitis
Dexamethasone	Corticosteroid	Bone loss; edema/weight gain; hyperglycemia; hypernatremia; hypertension; myopathy; neuropsychiatric disturbance; peptic ulcer disease; reactivation of latent infections (i.e., TB or strongyloidosis); secondary infections; venous thromboembolism
Interferon-α	Interferon	Elevated liver functions; flu-like symptoms; hematological cytopeniaInfusion reaction; local reaction; nausea/vomiting; neuropsychiatric disease
Interferon-β	Interferon	Elevated liver functions; flu-like symptoms; hematological cytopeniaInfusion reaction; local reaction; nausea/vomiting; neuropsychiatric disease
Siltuximab	Anti-interleukin 6 monoclonal antibody	Elevated liver enzymes; gastrointestinal perforation; headache/dizziness; hyperuricemia; hypersensitivity reaction; neutropenia; pruritis/rash; reactivation of latent infection (i.e., HBV); secondary infections
Sirulimab	Anti-interleukin 6 Receptor monoclonal antibody	Elevated liver enzymes; gastrointestinal perforation; hypersensitivity reaction; neutropenia; reactivation of latent infection (i.e., HBV); secondary infections
Tocilizumab	Anti-interleukin 6 Receptor monoclonal antibody	Elevated liver enzymes; gastrointestinal perforation; changes in platelets and lipids; hypersensitivity reaction; neutropenia; reactivation of latent infection (i.e., HBV); secondary infections

TB: Tuberculosis; HBV: Hepatitis B virus.