Experimental Pharmacotherapy for COVID-19: The Latest Advances.
Identifieur interne : 000493 ( Main/Exploration ); précédent : 000492; suivant : 000494Experimental Pharmacotherapy for COVID-19: The Latest Advances.
Auteurs : Pasquale Pagliano [Italie] ; Giuliana Scarpati [Italie] ; Carmine Sellitto [Italie] ; Valeria Conti [Italie] ; Anna Maria Spera [Italie] ; Tiziana Ascione [Italie] ; Ornella Piazza [Italie] ; Amelia Filippelli [Italie]Source :
- Journal of experimental pharmacology [ 1179-1454 ] ; 2021.
Abstract
The coronavirus infectious disease-2019 (COVID-19) has overwhelmed like a shock wave in a completely unprepared world. Despite coronavirus infections were involved in previous epidemic outbreaks, no antiviral agent was developed for specific treatment. As a consequence, since the beginning of this pandemic, both repositioned and experimental drugs were used to treat the infected patients without evidence of clinical efficacy. Just based on experience coming from the use of antiviral agents to treat other viruses (eg, lopinavir/ritonavir, remdesivir) and supposed antiviral or immunomodulatory activities of drugs with no approved antiviral indications (eg hydroxychloroquine, tocilizumab), clinicians have faced the ongoing pandemic. Currently, after about 9 months from the COVID-19 spread, there is still no antiviral agent capable of ensuring the cure of this syndrome. Clinical trials are beginning to confirm the benefits of some drugs, while for other compounds, efficacy and safety have not yet been confirmed. Randomized clinical trials (RCT) have denied or downsized the beneficial effects attributed to certain molecules, such as aminoquinolines, largely used in clinical practice at the beginning of COVID-19 spread. Conversely, at the same time, they have provided evidence for unexpected effectiveness of other agents that have been underutilized, such as steroids, which were not used in SARS treatment because of the threatened effect on viral replication. Evidence deriving from pathologic studies have demonstrated that the prothrombotic effects of SARS-CoV-2 can be prevented by heparin prophylaxis, underlining the need for personalized treatment for patients with severe disease. The main aim of this review is to synthesize the available information and evidence on both repositioned and experimental drugs for the treatment of COVID-19, focusing on the need to exercise caution on the use of unproven medical therapies.
DOI: 10.2147/JEP.S255209
PubMed: 33442304
PubMed Central: PMC7800714
Affiliations:
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wicri:level="1"><nlm:affiliation>Department of Medicine, Surgery and Dentistry, "Scuola Medica Salernitana", Unit of Infectious Diseases, University of Salerno, Baronissi, Italy.</nlm:affiliation><country xml:lang="fr">Italie</country><wicri:regionArea>Department of Medicine, Surgery and Dentistry, "Scuola Medica Salernitana", Unit of Infectious Diseases, University of Salerno, Baronissi</wicri:regionArea><wicri:noRegion>Baronissi</wicri:noRegion></affiliation></author><author><name sortKey="Scarpati, Giuliana" sort="Scarpati, Giuliana" uniqKey="Scarpati G" first="Giuliana" last="Scarpati">Giuliana Scarpati</name><affiliation wicri:level="1"><nlm:affiliation>Department of Medicine, Surgery and Dentistry, "Scuola Medica Salernitana", Unit of Anesthesiology, University of Salerno, Baronissi, Italy.</nlm:affiliation><country xml:lang="fr">Italie</country><wicri:regionArea>Department of Medicine, Surgery and Dentistry, "Scuola Medica Salernitana", Unit of Anesthesiology, University of Salerno, Baronissi</wicri:regionArea><wicri:noRegion>Baronissi</wicri:noRegion></affiliation></author><author><name sortKey="Sellitto, Carmine" sort="Sellitto, Carmine" uniqKey="Sellitto C" first="Carmine" last="Sellitto">Carmine Sellitto</name><affiliation wicri:level="1"><nlm:affiliation>Department of Medicine, Surgery and Dentistry, "Scuola Medica Salernitana", Unit of Pharmacology, University of Salerno, Baronissi, Italy.</nlm:affiliation><country xml:lang="fr">Italie</country><wicri:regionArea>Department of Medicine, Surgery and Dentistry, "Scuola Medica Salernitana", Unit of Pharmacology, University of Salerno, Baronissi</wicri:regionArea><wicri:noRegion>Baronissi</wicri:noRegion></affiliation></author><author><name sortKey="Conti, Valeria" sort="Conti, Valeria" uniqKey="Conti V" first="Valeria" last="Conti">Valeria Conti</name><affiliation wicri:level="1"><nlm:affiliation>Department of Medicine, Surgery and Dentistry, "Scuola Medica Salernitana", Unit of Pharmacology, University of Salerno, Baronissi, Italy.</nlm:affiliation><country xml:lang="fr">Italie</country><wicri:regionArea>Department of Medicine, Surgery and Dentistry, "Scuola Medica Salernitana", Unit of Pharmacology, University of Salerno, Baronissi</wicri:regionArea><wicri:noRegion>Baronissi</wicri:noRegion></affiliation></author><author><name sortKey="Spera, Anna Maria" sort="Spera, Anna Maria" uniqKey="Spera A" first="Anna Maria" last="Spera">Anna Maria Spera</name><affiliation wicri:level="1"><nlm:affiliation>Department of Medicine, Surgery and Dentistry, "Scuola Medica Salernitana", Unit of Infectious Diseases, University of Salerno, Baronissi, Italy.</nlm:affiliation><country xml:lang="fr">Italie</country><wicri:regionArea>Department of Medicine, Surgery and Dentistry, "Scuola Medica Salernitana", Unit of Infectious Diseases, University of Salerno, Baronissi</wicri:regionArea><wicri:noRegion>Baronissi</wicri:noRegion></affiliation></author><author><name sortKey="Ascione, Tiziana" sort="Ascione, Tiziana" uniqKey="Ascione T" first="Tiziana" last="Ascione">Tiziana Ascione</name><affiliation wicri:level="1"><nlm:affiliation>Department of Medicine, Service of Infectious Diseases, Cardarelli Hospital, Naples, Italy.</nlm:affiliation><country xml:lang="fr">Italie</country><wicri:regionArea>Department of Medicine, Service of Infectious Diseases, Cardarelli Hospital, Naples</wicri:regionArea><wicri:noRegion>Naples</wicri:noRegion></affiliation></author><author><name sortKey="Piazza, Ornella" sort="Piazza, Ornella" uniqKey="Piazza O" first="Ornella" last="Piazza">Ornella Piazza</name><affiliation wicri:level="1"><nlm:affiliation>Department of Medicine, Surgery and Dentistry, "Scuola Medica Salernitana", Unit of Anesthesiology, University of Salerno, Baronissi, Italy.</nlm:affiliation><country xml:lang="fr">Italie</country><wicri:regionArea>Department of Medicine, Surgery and Dentistry, "Scuola Medica Salernitana", Unit of Anesthesiology, University of Salerno, Baronissi</wicri:regionArea><wicri:noRegion>Baronissi</wicri:noRegion></affiliation></author><author><name sortKey="Filippelli, Amelia" sort="Filippelli, Amelia" uniqKey="Filippelli A" first="Amelia" last="Filippelli">Amelia Filippelli</name><affiliation wicri:level="1"><nlm:affiliation>Department of Medicine, Surgery and Dentistry, "Scuola Medica Salernitana", Unit of Pharmacology, University of Salerno, Baronissi, Italy.</nlm:affiliation><country xml:lang="fr">Italie</country><wicri:regionArea>Department of Medicine, Surgery and Dentistry, "Scuola Medica Salernitana", Unit of Pharmacology, University of Salerno, Baronissi</wicri:regionArea><wicri:noRegion>Baronissi</wicri:noRegion></affiliation></author></analytic><series><title level="j">Journal of experimental pharmacology</title><idno type="ISSN">1179-1454</idno><imprint><date when="2021" type="published">2021</date></imprint></series></biblStruct></sourceDesc></fileDesc><profileDesc><textClass></textClass></profileDesc></teiHeader><front><div type="abstract" xml:lang="en">The coronavirus infectious disease-2019 (COVID-19) has overwhelmed like a shock wave in a completely unprepared world. Despite coronavirus infections were involved in previous epidemic outbreaks, no antiviral agent was developed for specific treatment. As a consequence, since the beginning of this pandemic, both repositioned and experimental drugs were used to treat the infected patients without evidence of clinical efficacy. Just based on experience coming from the use of antiviral agents to treat other viruses (eg, lopinavir/ritonavir, remdesivir) and supposed antiviral or immunomodulatory activities of drugs with no approved antiviral indications (eg hydroxychloroquine, tocilizumab), clinicians have faced the ongoing pandemic. Currently, after about 9 months from the COVID-19 spread, there is still no antiviral agent capable of ensuring the cure of this syndrome. Clinical trials are beginning to confirm the benefits of some drugs, while for other compounds, efficacy and safety have not yet been confirmed. Randomized clinical trials (RCT) have denied or downsized the beneficial effects attributed to certain molecules, such as aminoquinolines, largely used in clinical practice at the beginning of COVID-19 spread. Conversely, at the same time, they have provided evidence for unexpected effectiveness of other agents that have been underutilized, such as steroids, which were not used in SARS treatment because of the threatened effect on viral replication. Evidence deriving from pathologic studies have demonstrated that the prothrombotic effects of SARS-CoV-2 can be prevented by heparin prophylaxis, underlining the need for personalized treatment for patients with severe disease. The main aim of this review is to synthesize the available information and evidence on both repositioned and experimental drugs for the treatment of COVID-19, focusing on the need to exercise caution on the use of unproven medical therapies.</div></front></TEI><pubmed><MedlineCitation Status="PubMed-not-MEDLINE" Owner="NLM"><PMID Version="1">33442304</PMID><DateRevised><Year>2021</Year><Month>01</Month><Day>15</Day></DateRevised><Article PubModel="Electronic-eCollection"><Journal><ISSN IssnType="Print">1179-1454</ISSN><JournalIssue CitedMedium="Print"><Volume>13</Volume><PubDate><Year>2021</Year></PubDate></JournalIssue><Title>Journal of experimental pharmacology</Title><ISOAbbreviation>J Exp Pharmacol</ISOAbbreviation></Journal><ArticleTitle>Experimental Pharmacotherapy for COVID-19: The Latest Advances.</ArticleTitle><Pagination><MedlinePgn>1-13</MedlinePgn></Pagination><ELocationID EIdType="doi" ValidYN="Y">10.2147/JEP.S255209</ELocationID><Abstract><AbstractText>The coronavirus infectious disease-2019 (COVID-19) has overwhelmed like a shock wave in a completely unprepared world. Despite coronavirus infections were involved in previous epidemic outbreaks, no antiviral agent was developed for specific treatment. As a consequence, since the beginning of this pandemic, both repositioned and experimental drugs were used to treat the infected patients without evidence of clinical efficacy. Just based on experience coming from the use of antiviral agents to treat other viruses (eg, lopinavir/ritonavir, remdesivir) and supposed antiviral or immunomodulatory activities of drugs with no approved antiviral indications (eg hydroxychloroquine, tocilizumab), clinicians have faced the ongoing pandemic. Currently, after about 9 months from the COVID-19 spread, there is still no antiviral agent capable of ensuring the cure of this syndrome. Clinical trials are beginning to confirm the benefits of some drugs, while for other compounds, efficacy and safety have not yet been confirmed. Randomized clinical trials (RCT) have denied or downsized the beneficial effects attributed to certain molecules, such as aminoquinolines, largely used in clinical practice at the beginning of COVID-19 spread. Conversely, at the same time, they have provided evidence for unexpected effectiveness of other agents that have been underutilized, such as steroids, which were not used in SARS treatment because of the threatened effect on viral replication. Evidence deriving from pathologic studies have demonstrated that the prothrombotic effects of SARS-CoV-2 can be prevented by heparin prophylaxis, underlining the need for personalized treatment for patients with severe disease. The main aim of this review is to synthesize the available information and evidence on both repositioned and experimental drugs for the treatment of COVID-19, focusing on the need to exercise caution on the use of unproven medical therapies.</AbstractText><CopyrightInformation>© 2021 Pagliano et al.</CopyrightInformation></Abstract><AuthorList CompleteYN="Y"><Author ValidYN="Y"><LastName>Pagliano</LastName><ForeName>Pasquale</ForeName><Initials>P</Initials><AffiliationInfo><Affiliation>Department of Medicine, Surgery and Dentistry, "Scuola Medica Salernitana", Unit of Infectious Diseases, University of Salerno, Baronissi, Italy.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Scarpati</LastName><ForeName>Giuliana</ForeName><Initials>G</Initials><AffiliationInfo><Affiliation>Department of Medicine, Surgery and Dentistry, "Scuola Medica Salernitana", Unit of Anesthesiology, University of Salerno, Baronissi, Italy.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Sellitto</LastName><ForeName>Carmine</ForeName><Initials>C</Initials><Identifier Source="ORCID">0000-0002-5595-7841</Identifier><AffiliationInfo><Affiliation>Department of Medicine, Surgery and Dentistry, "Scuola Medica Salernitana", Unit of Pharmacology, University of Salerno, Baronissi, Italy.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Conti</LastName><ForeName>Valeria</ForeName><Initials>V</Initials><AffiliationInfo><Affiliation>Department of Medicine, Surgery and Dentistry, "Scuola Medica Salernitana", Unit of Pharmacology, University of Salerno, Baronissi, Italy.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Spera</LastName><ForeName>Anna Maria</ForeName><Initials>AM</Initials><Identifier Source="ORCID">0000-0003-1292-3040</Identifier><AffiliationInfo><Affiliation>Department of Medicine, Surgery and Dentistry, "Scuola Medica Salernitana", Unit of Infectious Diseases, University of Salerno, Baronissi, Italy.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Ascione</LastName><ForeName>Tiziana</ForeName><Initials>T</Initials><AffiliationInfo><Affiliation>Department of Medicine, Service of Infectious Diseases, Cardarelli Hospital, Naples, Italy.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Piazza</LastName><ForeName>Ornella</ForeName><Initials>O</Initials><AffiliationInfo><Affiliation>Department of Medicine, Surgery and Dentistry, "Scuola Medica Salernitana", Unit of Anesthesiology, University of Salerno, Baronissi, Italy.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Filippelli</LastName><ForeName>Amelia</ForeName><Initials>A</Initials><AffiliationInfo><Affiliation>Department of Medicine, Surgery and Dentistry, "Scuola Medica Salernitana", Unit of Pharmacology, University of Salerno, Baronissi, Italy.</Affiliation></AffiliationInfo></Author></AuthorList><Language>eng</Language><PublicationTypeList><PublicationType UI="D016428">Journal Article</PublicationType><PublicationType UI="D016454">Review</PublicationType></PublicationTypeList><ArticleDate DateType="Electronic"><Year>2021</Year><Month>01</Month><Day>07</Day></ArticleDate></Article><MedlineJournalInfo><Country>New Zealand</Country><MedlineTA>J Exp Pharmacol</MedlineTA><NlmUniqueID>101530345</NlmUniqueID><ISSNLinking>1179-1454</ISSNLinking></MedlineJournalInfo><KeywordList Owner="NOTNLM"><Keyword MajorTopicYN="N">ARDS</Keyword><Keyword MajorTopicYN="N">SARS-CoV-2</Keyword><Keyword MajorTopicYN="N">chloroquine</Keyword><Keyword MajorTopicYN="N">heparin</Keyword><Keyword MajorTopicYN="N">remdesivir</Keyword><Keyword MajorTopicYN="N">steroids</Keyword></KeywordList><CoiStatement>The authors report no conflicts of interest for this work.</CoiStatement></MedlineCitation><PubmedData><History><PubMedPubDate PubStatus="received"><Year>2020</Year><Month>10</Month><Day>01</Day></PubMedPubDate><PubMedPubDate 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