Table 1 Current approved/authorized COVID-19 drugs: mechanisms of action in COVID-19, other uses, adverse effects, and precautions
From: What are the current anti-COVID-19 drugs? From traditional to smart molecular mechanisms
Drug | Indications in Covid 19 | Mechanism of action in COVID-19 | Other uses | Adverse Effects and Precautions |
|---|---|---|---|---|
I. Antiviral Drugs | ||||
Remdesivir | FDA-approved for the treatment of adults and pediatric patients with mild-to-moderate COVID-19 at high risk of disease progression | Adenosine analog inhibiting viral RNA-dependent RNA polymerase → inhibition of viral replication | Ebola virus | ↑ Liver transaminases |
Recommended by NIH, IDSA, and NICE guidelines | Effective against the Omicron variant | SARS-CoV-1 | ↑PT, Nausea | |
Hypersensitivity | ||||
Not recommended for patients with eGFR < 30 mL/min | ||||
Ritonavir/Nirmatrelvir (Paxlovid) | FDA-approved (May 2023) for the treatment of adults with mild-to-moderate COVID-19 at high risk of disease progression | A protease inhibitor | Diarrhea, impaired taste, hypertension, and myalgia | |
Recommended by NIH, IDSA, and NICE guidelines | Not recommended in patients with severe renal or hepatic impairment | |||
Used cautiously in patients with liver diseases | ||||
May induce HIV-1 drug resistance | ||||
Molnupiravir | FDA-authorized (December 2021) for the treatment of certain adults with mild-to-moderate COVID-19 at high risk of disease progression as an alternative to Paxlovid and remdesivir | Incorporates into viral RNA strands → ‘error catastrophe’ during viral replication | Diarrhea, nausea, and dizziness | |
Recommended by NIH, IDSA, and NICE guidelines | Effective against the Omicron variant | Not recommended in pregnancy and lactation | ||
Not authorized for patients ≤ 18 years with COVID-19 due to bone and cartilage growth affection | ||||
II. Anti-SARS-CoV2 antibody agents | ||||
Sotrovimab “Anti-SARS-CoV-2 monoclonal antibodies” | Sotrovimab is recommended by the NICE for the treatment of COVID-19 as an alternative to Paxlovid in patients with increased risk for disease progression only if they do not need supplemental O2 | Single mAb that binds to and blocks S-protein of SARS-CoV-2 | Hypersensitivity, anaphylaxis (infusion-related reactions) | |
Effective against Omicron variant (B.1) but not against subvariants B.2 | ||||
COVID-19 Convalescence Plasma (CCP) | FDA-authorized (August 2020) for the treatment of COVID-19 in patients with immunosuppressive disease or receiving immunosuppressive treatment | Antiviral effects of neutralizing antibodies (NAbs) IgM and IgG against S-protein | CCP is widely used in outbreaks and epidemics until reaching a definitive treatment | Mild allergic reaction, nausea, skin erythema, and fever |
Suggested by the IDSA in ambulatory patients with mild-to-moderate COVID-19 at high risk of disease progression who have no other treatment options | NAbs → ↓autoantibodies, cytokine storm, Th1/Th17 ratio, complement | Transmission of infection as HIV, HBV, or HCV | ||
NAbs → ↑ IL-10 | ||||
Regulate coagulation and ↓Clotting | ||||
III. Anti-inflammatory and immunomodulatory drugs | ||||
Corticosteroids | Life-saving—recommended by the WHO for patients with severe or critical COVID-19 | To suppress both acute respiratory distress syndrome (ARDS) and systemic inflammation | Wide range of uses including autoimmune diseases, inflammatory diseases, and organ transplantation | Hyperglycemia, neuropsychiatric symptoms, secondary infections with ↑risk of opportunistic fungal infections (e.g., mucormycosis, aspergillosis), and reactivation of latent infections (e.g., HBV, herpesvirus infections, and TB) |
Recommended by NIH, IDSA, and NICE guidelines | ||||
Interleukin-6 inhibitors | Tocilizumab is FDA-approved (December 2022) for the treatment of hospitalized adults with COVID-19 who are receiving systemic corticosteroids and require supplemental O2, mechanical ventilation, or ECMO | ↓ Cytokine storm | Rheumatoid arthritis and giant cell arteritis | Runny nose, sore throat, sinus infection, headache |
Tocilizumab | Recommended by NIH, IDSA, and NICE guidelines | High blood pressure | ||
Sarilumab | Injection site reactions | |||
GIT perforations | ||||
Interleukin-1 inhibitors | Anakinra is FDA-authorized (November 2022) for the treatment of hospitalized adults with COVID-19 with pneumonia requiring supplemental O2 who are at risk of disease progression and likely to have an elevated plasma soluble urokinase plasminogen activator receptor | ↓ Cytokine storm | Rheumatoid Arthritis | Headache, nausea, vomiting, and liver enzyme elevations |
Anakinra | Cryopyrin-associated periodic syndromes (CAPS) | |||
Canakinumab | ||||
JAK Inhibitors | Baricitinib is FDA-approved (May 2022) for the treatment of hospitalized adults with COVID-19 requiring supplemental O2, mechanical ventilation, or ECMO | Inhibits JAK1/JAK2 → inhibition of the inflammatory cascade | Rheumatoid arthritis | Hypersensitivity reactions |
Baricitinib | Recommended by NIH, IDSA, and NICE guidelines | Inhibits IL-6-induced STAT3 phosphorylation | Psoriatic arthritis | Infections: respiratory and urinary tract infections, reactivation of herps |
Tofacitinib | Inhibition of viral entry into the host cell | Ulcerative colitis | Myelosuppression, thrombosis, elevation of liver enzymes | |
Cardiac-related events (MI and stroke) | ||||
Baricitinib needs dose adjustment in renal patients | ||||
Vilobelimab | FDA-authorized (April 2023) for the treatment of hospitalized adults with COVID-19 when initiated within 48 h of receiving invasive mechanical ventilation or ECMO | A monoclonal antibody that binds to the soluble form of the complement component “C5a” → inhibits the inflammatory response → ↓ Cytokine storm | - | Pneumonia, sepsis |
Infections: herpes simplex, enterococcal infection, bronchopulmonary aspergillosis | ||||
Delirium | ||||
Pulmonary embolism, DVT | ||||
Hypertension | ||||
Elevated liver enzymes | ||||
Thrombocytopenia | ||||
Rash | ||||