Scientific evidence in the COVID-19 treatment: A comprehensive review

Abstract

In December 2019, cases of unknown origin pneumonia appeared in Wuhan, China; the causal agent of this pneumonia was a new virus of the coronaviridae family called severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2). According to the clinical severity, symptoms and response to the different treatments, the evolution of the disease is divided in three phases. We analysed the most used treatments for coronavirus disease 2019 and the phase in which they are supposed to be effective. In the viral phase, remdesivir has demonstrated reduction in recovery time but no mortality reduction. Other drugs proposed for viral phase such as convalescent plasma and lopinavir/ritonavir did not demonstrate to be effective. In the inflammatory phase, corticosteroids demonstrated reduction of 28-d mortality in patients who needed oxygen, establishing that a corticosteroid regimen should be part of the standard treatment of critically ill patients. There are other immunosuppressive and immunomodulatory treatments such as anakinra, sarilumab, tocilizumab, colchicine or baricitinib that are being studied. Other treatments that were proposed at the beginning, like hydroxichloroquine or azithromycin, demonstrated no efficacy and increased mortality when combined.

Keywords: COVID-19; SARS-CoV-2; Treatment; Viral phase; Inflammatory phase

Core Tip: Severe acute respiratory syndrome coronavirus-2 is responsible for the unknown pneumonia that appeared in Wuhan, China, in December 2019. Lots of known drugs have been proved for coronavirus disease 2019. Corticosteroids demonstrated reduction of 28-d mortality in patients who needed oxygen and remdesivir proved to be effective reducing recovery time. Other drugs need more evaluation before establishing their effectiveness.