Infection and Drug Resistance (Dec 2020)
Systematic Review on the Therapeutic Options for COVID-19: Clinical Evidence of Drug Efficacy and Implications
Abstract
Abdullahi Rabiu Abubakar,1 Ibrahim Haruna Sani,2 Brian Godman,3 Santosh Kumar,4 Salequl Islam,5 Iffat Jahan,6 Mainul Haque7 1Department of Pharmacology and Therapeutics, Faculty of Pharmaceutical Sciences, Bayero University, Kano, Nigeria; 2Unit of Pharmacology, College of Health Sciences, Yusuf Maitama Sule University, Kano, Nigeria; 3Strathclyde Institute of Pharmacy and Biomedical Sciences, University of Strathclyde, Glasgow, UK; 4Department of Periodontology and Implantology, Karnavati University, Gandhinagar 382422, India; 5Department of Microbiology, Jahangirnagar University, Savar, Dhaka 1342, Bangladesh; 6Department of Physiology, Eastern Medical College, Cumilla, Bangladesh; 7Unit of Pharmacology, Faculty of Medicine and Defence Health, Universiti Pertahanan Nasional Malaysia (National Defence University of Malaysia), Kuala Lumpur, 57000, MalaysiaCorrespondence: Mainul HaqueUnit of Pharmacology, Faculty of Medicine and Defence Health, Universiti Pertahanan Nasional Malaysia (National Defence University of Malaysia), Kem Perdana Sungai Besi, Kuala Lumpur 57000, MalaysiaTel + 60 10 926 5543Email [email protected]: A novel coronavirus-2 (SARS-CoV-2) was first identified in Wuhan, China, and quickly spread globally. Several treatments have been proposed, many of which have proven ineffective. Consequently, there is a need to review the published evidence of drug clinical trials to guide future prescribing. A systematic review of published clinical trials and retrospective observational studies was carried out. The search was made using PubMed, Embase, MEDLINE, and China National Knowledge Infrastructure (CNKI) databases. Articles published between January 2020 and October 2020 and written in the English language were retrieved and included in the study. Researches that used traditional medicine, in-vitro and in-vivo animal studies, as well as reviews were excluded. Seventy-three relevant articles that fulfilled the inclusion criteria were finally selected and reviewed. Hydroxychloroquine, chloroquine, and azithromycin produced no clinical evidence of efficacy in randomized controlled clinical trials (RCT). However, retrospective observational studies reported the efficacy of remdesivir and lopinavir/ritonavir in reducing viral load, although there have been concerns with lopinavir/ritonavir and, more recently, remdesivir. Recently, tocilizumab, dexamethasone, and methylprednisolone significantly relieved lung inflammation and decreased mortality in patients with severe COVID-19. In addition, convalescent plasma was effective in boosting strong immunity among patients with mild COVID-19. There is currently no single worldwide approved therapeutic option for patients with COVID-19 despite the initial hype with medicines, including hydroxychloroquine. Nonetheless, dexamethasone has shown promise in symptomatic treatment and convalescent plasma in boosting immunity. New treatments are currently being researched, and the findings will be reported accordingly to provide evidence-based guidance for prescribers and policymakers.Keywords: COVID-19, efficacy, remdesivir, hydroxychloroquine, dexamethasone, lopinavir/ritonavir, clinical-trials, therapeutic-option
