Current Status and Prospects of Drugs to Treat Coronavirus Disease 2019 (COVID-19)

 Remdesivir Receives FDA Approval

One of the first drugs to show promise in clinical trials for the treatment of COVID-19 was remdesivir. Remdesivir is a broad-spectrum antiviral medication developed by Gilead Sciences that works by inhibiting viral RNA polymerase, preventing a virus from multiplying. In May 2020, remdesivir received Emergency Use Authorization from the FDA for the treatment of hospitalized patients with severe COVID-19. Then, in October 2020, the FDA formally approved remdesivir under the brand name Veklury for the treatment of COVID-19 in adults and pediatric patients 12 years of age and older weighing at least 40 kg requiring hospitalization.

Clinical trials showed that remdesivir helped hospitalized patients with COVID-19 recover more quickly than patients receiving a placebo. In one trial conducted by the National Institute of Allergy and Infectious Diseases, patients receiving remdesivir had a median recovery time of 10 days compared to 15 days for patients receiving the placebo. In another study conducted in multiple countries, remdesivir helped reduce the risk of death in severely ill patients by 62% compared to standard care. While remdesivir is not a cure, it does help speed up recovery time for hospitalized Coronavirus Treatment Drugs patients. However, its availability is limited, and it remains an expensive treatment option.

Dexamethasone Proves Effective for Severe Cases

Another drug that demonstrated effectiveness against severe COVID-19 was the corticosteroid dexamethasone. Dexamethasone is an inexpensive, generic corticosteroid which has been used since the 1960s to reduce inflammation in a wide range of conditions. In a large UK-led clinical trial known as the RECOVERY Trial, researchers gave dexamethasone to over 2,000 severely ill COVID-19 patients and compared them to over 4,000 patients who received standard care without dexamethasone.

Coronavirus Treatment Drugs

The results showed that dexamethasone reduced deaths by one-third in ventilated patients and by one-fifth in other patients receiving oxygen only. Dexamethasone did not provide any benefit for patients who did not require respiratory support. Based on these results, dexamethasone is now recommended for treatment in hospitalized patients with severe or critical COVID-19. Its low cost and widespread availability have made dexamethasone an indispensable drug for reducing mortality in severe COVID-19 cases globally. However, it should not be used in patients with milder cases as it can potentially cause harm.

Monoclonal Antibody Therapies Enter the Picture

Early in the pandemic, scientists were optimistic that monoclonal antibody therapies could prove useful for both prevention and treatment of COVID-19. These antibodies are laboratory-produced molecules that act like human antibodies in the immune system. The first monoclonal antibody therapy to receive an FDA emergency use authorization for COVID-19 was bamlanivimab developed by Eli Lilly. However, subsequent variants proved resistant to this first-generation antibody.

More promising have been combinations of monoclonal antibodies. Regeneron's cocktail casirivimab and imdevimab was granted EUA for treatment of mild-to-moderate COVID-19 in high-risk patients. Clinical trials showed it reduced the risk of hospitalization or death by 70% when given shortly after symptoms appear. Another monoclonal antibody treatment called sotrovimab developed by GlaxoSmithKline received EUA for treatment of mild-to-moderate COVID-19 in May 2021. It was found effective against variants of concern. The availability of monoclonal antibodies provides physicians with effective therapies for treating early-stage COVID-19, especially in immunocompromised patients.

Multiple Efforts Underway Targeting Different Stages of Illness

While progress has been made in treating hospitalized patients, additional drug development efforts are targeting different stages of COVID-19 illness. Early illness is being targeted by oral antivirals that could be prescribed like a normal antibiotic. Molnupiravir developed by Merck and Ridgeback Biotherapeutics has shown promise in reducing hospitalization rates when given early after symptom onset. Pfizer's paxlovid pill significantly reduced hospitalizations and deaths in trials. It works by inhibiting viral proteases essential for viral replication. Both could receive authorizations before the end of 2021.

Ongoing pharmaceutical company efforts also include new monoclonal antibodies with longer-lasting activity and potential to counter variants of concern. Another area of interest is drugs that could prevent or treat long COVID syndrome by reducing inflammation. Improved treatments are also sought for multisystem inflammatory syndrome in children, a rare but potentially life-threatening post-viral complication of COVID-19. Overall, a multi-pronged strategy targeting different stages of illness from mild to severe holds the best promise in controlling the pandemic as new variants continue emerging. While vaccination remains the primary prevention tool, new drug treatments will continue playing a supportive role.

In summary, significant progress has been made with drugs like remdesivir, dexamethasone and monoclonal antibodies against COVID-19. These have helped reduce mortality among hospitalized patients and provided options for outpatient treatment. However, no single magic bullet has yet appeared. Control of the pandemic will depend on a combination of preventive strategies including vaccination as well as curative therapies tailored to address different stages of disease. Multiple drug candidates are in testing and have the potential to expand the therapeutic armamentarium in the continual battle against SARS-CoV-2 virus. While promising data emerge regularly, rigorous evaluation in well-designed clinical trials remains essential to guide safe, evidence-based use of these treatments as the pandemic evolves.

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