Lessons we learned during the past four challenging years in the COVID-19 era: pharmacotherapy, long COVID complications, and vaccine development

Ghasemiyeh, Parisa; Mohammadi-Samani, Soliman

doi:10.1186/s12985-024-02370-6

Virology Journal

Table 2 Latest recommendations on most commonly considered therapeutic agents in COVID-19 treatment

From: Lessons we learned during the past four challenging years in the COVID-19 era: pharmacotherapy, long COVID complications, and vaccine development

Pharmacologic category	Drug name	Latest recommendations	Ref.
Antiviral drugs	Remdesivir	• Received FDA approval for COVID-19 treatment. • Recommended for the treatment of both hospitalized and non-hospitalized COVID-19 patients. • Remdesivir can be administered without dose adjustment in COVID-19 patients with renal dysfunction (eGFR < 30 mL/min) and also in patients who are on dialysis.	[34, 36,37,38]
	Ritonavir-boosted nirmatrelvir (Paxlovid)	• Received Emergency Use Authorizations (EUA) from the FDA for the COVID-19 treatment. • Recommended for the treatment of non-hospitalized COVID-19 patients.	[34, 39, 40]
	Molnupiravir	Only should be used in non-hospitalized patients when Remdesivir and Paxlovid are not available.	[34, 39, 41]
Anti-SARS-CoV-2 monoclonal antibodies	Bebtelovimab	Recommended the use for mild to moderate COVID-19 only when remdesivir and Paxlovid are not available.	[34, 42, 43]
	Vilobelimab	Emergency Use Authorization (EUA) by Food and Drug Administration (FDA) to administer within 48 h of mechanical ventilation or extracorporeal membrane oxygenation (ECMO) in hospitalized adult COVID-19 patients.	[44]
	Bamlanivimab plus Etesevimab	Recommended against the use for the treatment of COVID-19 or post-exposure prophylaxis.	[34, 45]
	Casirivimab plus Imdevimab	• Recommended against the use for the treatment of COVID-19 or post-exposure prophylaxis. • Casirivimab plus Imdevimab are not effective against the Omicron variant and should not be used as prophylactic agents.	[34, 46]
	Sotrovimab	Recommended against the use for the treatment of COVID-19 or post-exposure prophylaxis.	[34, 47]
COVID-19 convalescent plasma		Recommended against the use for COVID-19 treatment.	[34, 48, 49]
Cell-Based Therapy	Mesenchymal stem cells	Recommended against the use for COVID-19 treatment except in clinical trials.	[34, 50]
Immunomodulators	Colchicine	Recommended against the use for hospitalized and non-hospitalized COVID-19 patients.	[34, 51, 52]
	Intravenous immunoglobulin (IVIG)	Recommended against the use for the treatment of patients with acute COVID-19 except in clinical trials.	[34, 52]
	Inhaled corticosteroids	Insufficient data available to recommend for or against the use in COVID-19 treatment.	[34, 53, 54]
	Fluvoxamine	Insufficient data available to recommend for or against the use in COVID-19 treatment.	[34, 39, 55]
	Granulocyte-Macrophage Colony-Stimulating Factor Inhibitors	Insufficient data available to recommend for or against the use in COVID-19 treatment.	[34, 56]
	Systemic corticosteroids: Dexamethasone	Recommended for the use in hospitalized COVID-19 patients based on disease severity.	[34, 57,58,59]
	Inhaled corticosteroids: • Inhaled budesonide plus fluvoxamine • Inhaled fluticasone	Insufficient data available to recommend for or against the use in COVID-19 treatment.	[60]
	IL-1 inhibitors: Anakinra	Insufficient data available to recommend for or against the use in COVID-19 treatment.	[34, 61]
	IL-6 inhibitors: Tocilizumab	Recommended for the use in hospitalized COVID-19 patients based on disease severity.	[34, 62, 63]
	Janus Kinase Inhibitors: Barictinib (or Tofacitinib)	• Recommended for the use in hospitalized COVID-19 patients based on disease severity. • Recommended against the use of baricitinib plus tocilizumab except in clinical trials.	[34, 64, 65]
	Bruton’s Tyrosine Kinase (BTK) Inhibitors (ibrutinib or acalabrutinib)	Recommended against the use for COVID-19 treatment except in clinical trials.	[34, 66]
	Siltuximab	Recommended against the use for COVID-19 treatment except in clinical trials.	[34, 67]
	Canakinumab	Recommended against the use for COVID-19 treatment except in clinical trials.	[34, 68]
Antithrombotic Therapy	Anticoagulant therapy	• Recommended against the use in non-hospitalized COVID-19 patients or continuing in those after hospital discharge. • Unfractionated heparin (UFH) and low molecular weight heparin (LMWH) are superior to oral anticoagulants in hospitalized patients. • Consider the therapeutic doses of heparin in hospitalized non-critically ill COVID-19 patients who receive low-flow oxygen. • Recommended the prophylactic doses of heparin in critically ill COVID-19 patients. • Recommended against the therapeutic dose of rivaroxaban for venous thromboembolism (VTE) prophylaxis or for prevention of COVID-19 disease progression. • Insufficient data available regarding the administration of the therapeutic dose of apixaban for VTE prophylaxis or for prevention of COVID-19 disease progression. • Recommended against the continuation of VTE prophylaxis in COVID-19 patients after hospital discharge	[34, 69,70,71]
Antithrombotic Therapy	Antiplatelet therapy	• Recommended against the use in non-hospitalized COVID-19 patients. • Those who are receiving antiplatelet or anticoagulant for an underlying disease should continue therapy during COVID-19 infection.	[34, 72, 73]
Supplements	Vitamin C	Insufficient data available to recommend for or against the use in COVID-19 treatment.	[34, 74, 75]
	Zinc	• Insufficient data available to recommend for or against the use in COVID-19 treatment. • Recommended against the administration of zinc over than recommended dietary allowance (RDA) for COVID-19 prophylaxis.	[34, 75, 76]
	Vitamin D	Insufficient data available to recommend for or against the use in COVID-19 treatment.	[34, 77, 78]

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