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Prospects for a COVID-19 treatment: review

https://doi.org/10.18705/2311-4495-2020-7-3-30-37

Abstract

In the context of the new coronavirus infection spreading it is particularly relevance to obtain information on the clinical course, diagnostic possibilities and features of the COVID-19 treatment. By May 2020 in the world more than 4 million people were infected by the SARS-CoV-2 virus and more than 300 thousand died. In this review data about the clinical course, diagnostic possibilities and treatment of patients with COVID-19 are present. The authors analyzed publications presented in local and international databases from December 2019 to May 2020 on the new coronavirus infection. According to the analysis the most frequent symptoms described in literature wee fever, weakness, cough, dyspnea, gastroenterological manifestation and smell dysfunction. The main methods of diagnostic are the results of clinical evaluation, computer tomography and molecular genetic methods of examination. The treatment of his infection is limited by the absence of etiological treatment and the need for symptomatic therapy. All data presented in COVID-19 treatment trials have efficacy not more than 65 %, among which lopinavir/ritonavir shows the lowest result (20 %), hydroxychloroquine and tocilizumab show better results (45 and 65 % respectively). Great hope rests on the effectiveness of immunosuppressive therapy. Moreover, all treating methods don’t reduce mortality, which is 13–22 % regardless of the treatment type.

About the Authors

A. A. Starshinova
Almazov National Medical Research Centre
Russian Federation

Starshinova Anna A., Dr. Sci, MD, Head of the Research Department

Akkuratova str. 2, Saint Petersburg, Russia, 197341


Competing Interests:

The authors declare no conflict of interest



E. A. Kushnareva
Almazov National Medical Research Centre
Russian Federation

Kushnareva Ekaterina A., PhD Student

Saint Petersburg


Competing Interests: The authors declare no conflict of interest


D. A. Kudlay
National Research Center - Institute of Immunology Federal Medical-Biological Agency of Russia
Russian Federation

Kudlay Dmitry A., Dr. Sci., MD, Leading Researcher, Laboratory of Personalized Medicine and Molecular Immunology No. 71

Moscow


Competing Interests: The authors declare no conflict of interest


I. F. Dovgalyuk
Saint Petersburg State Research Institute of Phthisiopulmonology of the Ministry of Healthcare of the Russian Federation
Russian Federation

Dovgalyuk Irina F., Professor, Dr. Sci., Leading Researcher, Head of Phthisopediatrics Department

Saint Petersburg


Competing Interests: The authors declare no conflict of interest


References

1. Zhu N, Zhang D, Wang W, et al. A novel coronavirus from patients with pneumonia in China, 2019. N. Engl. J. Med. 2020; 382(8): 727–733.

2. Dong Y, Mo X, Hu Y, et al. epidemiological characteristics of 2143 pediatric patients with 2019 coronavirus disease in China. Pediatrics. 2020; 145(6): e20200702.

3. World Health Organization. Coronavirus disease (COVID-19) Pandemic. Geneva: WHO, 2020. https://www.who.int/emergencies/diseases/novel-coronavirus-2019 (17 May 2020).

4. Davis BM, Foxman B, Monto AS, et al. Human coronaviruses and other respiratory infections in young adults on a university campus: prevalence, symptoms, and shedding. Influenza Other Respir Viruses. 2018; 12(5): 582–590.

5. Kuypers J, Martin ET, Heugel J, et al. Clinical disease in children associated with newly described coronavirus subtypes. Pediatrics. 2007; 119(1): e70–e76.

6. Huang YI, Lau SKP, Woo PCY, et al. CoVDB: a comprehensive database for comparative analysis of coronavirus genes and genomes. Nucleic. Acids. Res. 2008. 36: D504–D511.

7. Lau SKP, Lee P, Tsang AKL et al. Molecular epidemiology of human coronavirus OC43 reveals evolution of different genotypes over time and recent emergence of a novel genotype due to natural recombination. J. Virol. 2011; 85 (21): 11325–11337.

8. Menachery VD, Yount Jr BL, Debbink K, et al. A SARS-like cluster of circulating bat coronaviruses shows potential for human emergence. Nat. Med. 2015; 21(12): 1508–1513.

9. Cao B, Wang Y, Wen D et al. A Trial of lopinavir–ritonavir in adults hospitalized with severe Covid-19. N. Engl. J. Med. 2020; 382(19): 1787–1799.

10. Zeiser R, von Bubnoff N, Butler J, et al. Ruxolitinib for glucocorticoid-refractory acute graft-versus-host disease. N. Engl. J. Med. 2020; 382(19):1800–1810.

11. Grein J, Ohmagari N, Shin D, et al. Compassionate use of remdesivir for patients with severe Covid-19. N. Engl. J. Med. 2020; 382(24): 2327–2336.

12. Wang Y, Zhang D, Du G, et al. Remdesivir in adults with severe COVID-19: a randomised, doubleblind, placebo-controlled, multicentre trial. Lancet. 2020; 395(10236): 1569–1578.

13. Geleris J, Sun Y, Platt J, et al. Observational study of hydroxychloroquine in hospitalized patients with Covid-19. N. Engl. J. Med. 2020; 382(25): 2411–2418.

14. Liu J, Liao X, Qian S, et al. Community transmission of severe acute respiratory syndrome coronavirus 2, Shenzhen, China. Emerg. Infect. Dis. 2020; 26(6): 1320–1323.

15. Wang FS, Zhang C. What to do next to control the 2019-nCoV epidemic? Lancet. 2020; 395(10222): 391–393.

16. Mehra MR, Desai SS, Kuy S, et al. Cardiovascular disease, drug therapy and mortality in Covid-19. N. Engl. J. Med. 2020; 382(26): 2582.

17. Lupia T, Scabini S, Pinna MS, et al. 2019 novel coronavirus (2019-nCoV) outbreak: a new challenge. J. Glob. Antimicrob. Resist. 2020; 21: 22–27.

18. Xu X, Han M, Li T, et al. Effective treatment of severe COVID-19 patients with tocilizumab. Proc. Natl. Acad. Sci. USA. 2020; 117(20): 10970–10975.

19. Rosa SGV, Santos WC. Clinical trials on drug repositioning for COVID-19 treatment. Rev Panam Salud Publica. 2020; 44: e40.

20. Li Y, Xie Z, Lin Wet al. Efficacy and safety of lopinavir/ritonavir or arbidol in adult patients with mild/ moderate COVID-19: an exploratory randomized controlled trial. Med. [published online ahead of print, 2020 May 19].

21. Gautret Ph, Lagier J-Ch, Parola Ph, et al. Hydroxychloroquine and azithromycin as a treatment of COVID-19: results of an open-label non-randomized clinical trial. Int. J. Antimicrob. Agents. 2020; 105949.

22. Gautret P, Lagier J-C, Parola P, et al. Clinical and microbiological effect of a combination of hydroxychloroquine and azithromycin in 80 COVID-19 patients with at least a six-day follow up: A pilot observational study. Travel Med. Infect. Dis. 2020; 34: 101663.

23. Geleris J, Sun Y, Platt J, et al. Observational study of hydroxychloroquine in hospitalized patients with Covid-19. N. Engl. J. Med. 2020; 382(25): 2411–2418.

24. Tarrytown NY. Regeneron and Sanofi Provide update on U.S. Phase 2/3 adaptive-designed trial of Kevzara® (SARILUMAB) in hospitalized Covid-19 patients. Regeneron. https://investor.regeneron.com/news-releases/news-release-details/regeneron-and-sanofiprovide-update-us-phase-23-adaptive (27 April 2020).

25. Cavalli G, De Luca G, Campochiaro C, et al. Interleukin-1 blockade with high-dose anakinra in patients with COVID-19, acute respiratory distress syndrome, and hyperinflammation: a retrospective cohort study. Lancet Rheumatol. 2020; 2(6): e325–e331.

26. Cantini F, Niccoli L, Matarrese D, Nicastri E, et al. Baricitinib therapy in COVID-19: a pilot study on safety and clinical impact. J. Infect. 2020; S0163-4453(20): 30228–30230.

27. World Health Organization. Clinical management of severe acute respiratory infection (SARI) when COVID-19 disease is suspected: interim guidance. Geneva. 2020. https://www.who.int/publications-detail/clinicalmanagement-of-severe-acute-respiratory (13 March 2020).

28. Chu CM, Cheng VCC, Hung IFN, et al. Role of lopinavir/ritonavir in the treatment of SARS: initial virological and clinical findings. Thorax 2004; 59(3): 252–256.

29. Gordon CJ, Tchesnokov EP, Feng JY, et al. The antiviral compound remdesivir potently inhibits RNAdependent RNA polymerase from Middle East respiratory syndrome coronavirus. J. Biol. Chem. 2020; 295(15): 4773–4779.

30. Shlyakho EV, Konradi AO, Arutyunov GP, et al. Guidelines for the diagnosis and treatment of circulatory diseases in the context of the COVID-19 pandemic. Russ. J. Cardiol. 2020; 25(3): 129–148. In Russian. [Шляхто Е.В., Конради А.О., Виллевальде С.В., и др. Руководство по диагностике и лечению болезней системы кровоо- бращения в контексте пандемии COVID-19. Российский кардиологический журнал. 2020; 25(3): 129–148].

31. A collection of guidelines, algorithms for the actions of medical workers at various stages of care, checklists and standard documents developed for the period of presence and threat of further spread of a new coronavirus infection in St. Petersburg, version 1.0 dated 17.04.2020. SPb, 2020. 157 p. In Russian [Сборник методических рекомендаций, алгоритмов действий медицинских работников на различных этапах оказания помощи, чек-листов и типовых документов, разработанных на период наличия и угрозы дальнейшего распространения новой коронавирусной инфекции в Санкт-Петербурге, версия 1,0 от 17.04.2020. СПб, 2020. 157 с.].

32. Temporary guidelines “Prevention, diagnosis and treatment of new coronavirus infection (COVID-19)” (version 6, dated 04.24.2020), 142 p. In Russian. [Временные методические рекомендации «Профилактика, диагностика и лечение новой коронавирусной инфекции (COVID-19)», версия 6 от 24.04.2020. 142 с.].

33. Beigel JH, Tomashek KM, Dodd LE, et al. Remdesivir for the treatment of Covid-19 — preliminary report. N. Engl. J. Med. [published online ahead of print, 2020 May 22].

34. Clinical study evaluating the efficacy of faviprevir in COVID-19 treatment. https://www.clinicalkey.com/#!/content/clinical_trial/24-s2.0-NCT04351295. (17 May 2020).

35. Chen F, Chan KH, Jiang Y, et al. In vitro susceptibility of 10 clinical isolates of SARS coronavirus to selected antiviral compounds. J. Clin. Virol. 2004; 31(1): 69–75.

36. Moore JB, June CH. Cytokine release syndrome in severe COVID-19. Science 2020; 368(6490): 473–474.

37. Treatment of serious and critical patients with COVID-19 with tocilizumab. https://www.clinicalkey.com/#!/content/clinical_trial/24-s2.0-NCT04363853. (17 May 2020).

38. Multicenter study on the efficacy and tolerability of tocilizumab in the treatment of patients with COVID-19 pneumonia. https://www.clinicalkey.com/#!/content/clinical_trial/24-s2.0-NCT04317092. (17 May 2020).

39. Schwartz DM, Kanno Y, Villarino A, et al. JAK inhibition as a therapeutic strategy for immune and inflammatory diseases. Nat. Rev. Drug. Discov. 2017; 16(12): 843–862.

40. Phase 3 randomized, double-blind, placebocontrolled multi-center study to assess the efficacy and safety of ruxolitinib in patients with COVID-19 associated cytokine storm (RUXCOVID). https://www.clinicalkey.com/#!/content/clinical_trial/24-s2.0-NCT04362137. (17 May 2020).

41. Ye M, Fu D, Ren Y, et al. Treatment with convalescent plasma for COVID-19 patients in Wuhan, China. J. Med. Virol. [published online ahead of print, 2020 Apr 15].

42. Rajendran K, Krishnasamy N, Rangarajan J, et al. Convalescent plasma transfusion for the treatment of COVID-19: Systematic review. J. Med. Virol. [published online ahead of print, 2020 May 1].


Review

For citations:


Starshinova A.A., Kushnareva E.A., Kudlay D.A., Dovgalyuk I.F. Prospects for a COVID-19 treatment: review. Translational Medicine. 2020;7(3):30-37. (In Russ.) https://doi.org/10.18705/2311-4495-2020-7-3-30-37

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ISSN 2311-4495 (Print)
ISSN 2410-5155 (Online)