COVID-19: A Review of Potential Treatments (Corticosteroids, Remdesivir, Tocilizumab, Bamlanivimab/Etesevimab, and Casirivimab/Imdevimab) and Pharmacological Considerations

Abstract

Objectives: In light of the ongoing global pandemic, this paper reviews data on a number of potential and approved agents for COVID-19 disease management, including corticosteroids, remdesivir, tocilizumab, and monoclonal antibody combinations. Dose considerations, potential drug–drug interactions, and access issues are discussed. Key findings: Remdesivir is the first antiviral agent approved for the treatment of COVID-19, based on results from large clinical trials showing reduction in recovery time, faster clinical improvement, and decrease in time to discharge with remdesivir. Dexamethasone and tocilizumab have demonstrated mortality benefits in large, randomized controlled trials. Consequently, the use of corticosteroids has become the standard of care for hospitalized patients with severe or critical COVID-19, while tocilizumab is recommended for use in combination with a corticosteroid in certain hospitalized patients. Recently, monoclonal antibody combinations bamlanivimab/etesevimab and casirivimab/imdevimab received emergency use authorizations for use in non-hospitalized patients with mild-to-moderate COVID-19 at high risk of disease progression. Summary: As data from large clinical trials emerge, the paradigm of COVID-19 treatments has shifted significantly. The use of corticosteroids, remdesivir, and tocilizumab depend on disease severity. Emerging data on monoclonal antibody combinations are promising, but further data are required. Pharmacists can play a role in ensuring appropriate access, correct administration, and safe use of COVID-19 treatments and are encouraged to stay abreast of new developments.

The impact of casirivimab-imdevimab antibody cocktail in patients amidst and post COVID 19 treatment: A retro-prospective comparative study in India

“…Their test population did not show viral load for greater than a week. 5 , 18 However, in our study, there was no difference across the antibody-treated group and the standard group confined to the length of hospital stay and reversion to COVID negative status (p > 0.5). From an ongoing phase 1 to 3 clinical trial, very limited patients administered with the antibody cocktail demanded medical attention within 29 days.…”

Molnupiravir and Its Antiviral Activity Against COVID-19

“…The main drug groups include inhibitors of virus entry into cells (chloroquine, hydroxychloroquine, camostat mesylate, human recombinant soluble ACE2, neutralizing antibodies, nanobodies, miniproteins, convalescent plasma, umifenovir, nitazoxanide, whey protein and lactoferrin) ( 4 – 15 ), inhibitors of SARS-CoV-2 RNA (remdesivir, ribavirin, favipiravir, molnupiravir, and AT-527) ( 16 – 20 ), inhibitors of viral 3CL proteases (lopinavir/ritonavir, PF-07321332, PF-07304814, GC376, and GS-621763) ( 21 – 25 ), inhibitors of host factors essential for virus infection (plitidepsin, fluvoxamine, and ivermectin) ( 26 – 28 ), immunomodulators (dexamethasone, tocilizumab, sarilumab, bevacizumab, eculizumab, and interferons) ( 29 – 35 ). Currently, the U.S. Food and Drug Administration (FDA) has approved remdesivir and several neutralizing antibodies such as bamlanivimab, etesevimab, casirivimab and imdevimab for the treatment of hospitalized COVID-19 patients ( 36 ). However, their extensive usage was limited by the complex intravenous administration route and high cost ( 37 , 38 ).…”

Scope of repurposed drugs against the potential targets of the latest variants of SARS-CoV-2

“…Drugs such as lopinavir, ritonavir, remdesivir, ribavirin, and favipiravir are some repurposed drugs. Lopinavir/ritonavir was generally used against HIV [106], remdesivir against major SARS viruses [107], and favipiravir which was previously used as a general viral pro-drug [108]. With the advent of research techniques to identify more repurposed drugs, several other candidates have come up, evidencing the successful implementation of repositioning.…”