Opinion Review
Copyright ©The Author(s) 2020.
World J Virol. Sep 25, 2020; 9(3): 27-37
Published online Sep 25, 2020. doi: 10.5501/wjv.v9.i3.27
Table 1 Summary of the most investigated drugs for the treatment of coronavirus disease 2019
Therapeutic agentMechanism of actionOngoing trials, nAssociationsSuggested dosageRoute of administrationPrincipal side effectsRef.NCT identifier
HydroxychloroquineChanges the pH of endosomes, prevents viral entry, transport and post-entry replication224Azithromycin, tocilizumab, lopinavir-ritonavir200 mg BID or TID (10 d)Oral-intravenousRetinal toxicity, QT prolongation, nausea[6-10]NCT04315948
ChloroquineIncreases the endosomal pH interfering with the process of virus/cell fusion225Remdesivir, tocilizumab2.5 g (3 d)Oral-intravenousRetinal toxicity, QT prolongation, nausea[11]NCT04303507
Convalescent plasmaAdaptive immunotherapy (neutralizing antibody tiers above 1:640)129Remdesivir, Interferon-alpha, oseltamivir, antibacterial and antifungal frugal drugs, methylprednisolone200 ml single doseIntravenousEvanescent facial red spot[37-41]NCT04321421
Lopinavir/RitonavirInhibition of the HIV protease/inhibition of CitP450-iso3A4 and augmented plasmatic concentration of lopinavir67Hydroxychloroquine, azithromycin, dexamethasone200 mg/50 mg BIDOralGastrointestinal upset, augmented plasmatic concentration of colchicine[25-28]NCT02735707
And HGAM-CoA reductase inhibitors
AzithromycinProphylaxis of bacterial super-infection59Hydroxychloroquine, tocilizumab, atovaquone500 mgOral-intravenousQT prolongation[19-24]NCT04332107
TocilizumabMonoclonal antibody which targets the IL-6 receptor50lopinavir-ritonavir, remdesivir, chloroquine, hydroxychloroquineDosing according to weight rangeIntravenousRunny or stuffy nose, sinus pain, sore throat, headache, gastrointestinal upset, urinary tract infection[30]NCT04320615
IvermectinSuppression of SARS-CoV-2 viral replication in cell cultures (in vitro)30Hydroxychloroquine600 mcg/kgOralTiredness, loss of energy, stomach pain, loss of appetite, nausea, vomiting, diarrhea, dizziness[48]NCT04381884
StatinReduces chemokine release, adhesion molecules, and modulating T cell activity23Standard of care; colchicine + rosuvastatin20 mg/d atorvastatin Rosuvastatin 40 mg/d or equivalentOralrabdomiolisis[12]NCT04472611
RemdesivirNucleotide analogue that is incorporated into the nascent viral RNA chain resulting in its premature termination20Hydroxychloroquine, chloroquine, tocilizumab, convalescent plasma200 mg 1st day – 100 mg (10 d)IntravenousPhlebitis, constipation, headache, ecchymosis, nausea, pain in extremities[13-18]NCT04292899
MethylprednisoloneImmunosuppression against cytokine storm17Siltuximab, tacrolimus40 mg BID (5 d) - f 1-2 mg/kg/d (5-7 d)Oral-intravenousHeadache, nausea, weight gain, excitement, infections[35]NCT04323592
SarilumabMonoclonal antibody which targets the IL-6 receptor17Not available400 mg or 200mg single doseIntravenousNeutropenia, increased ALT, injection site redness, upper respiratory infections, nasal congestion, sore throat, urinary tract infections, thrombocytopenia[29]NCT04315298
ColchicineNon-selective inhibitor of NLRP3 inflammasome, inhibitor of microtubule polymerization and leukocyte infiltration17Not available0.5 mg per os (BID) for 3 d - then once daily for the last 27 dOral-intravenousGastrointestinal upset, low blood cells count and rhabdomyolysis[33-34]NCT04322682
HeparinInhibition of Xa factor and thrombin15MethylprednisoloneDosed to target activated partial thromboplastin time (aPTT) between 1.5-2.0 times the normal valueSubcutaneous injectionReduced creatinine clearance[45]NCT04485429
AnakinraMonoclonal antibody which targets the IL-1 receptor11Siltuximab or tocilizumab (single i.v. injection)1 injection a day (max 28 d)Subcutaneous injectionGastrointestinal upset, headache, joint pain, flu symptoms, redness-bruising-pain in the injection site[30,31]NCT04330638
DexamethasoneImmunosuppression against cytokine storm10Not available20 mg/d (5 d) then 10 mg/d (5 d)IntravenousHeadache, weight gain, excitement, infections[36]NCT04325061
EnoxaparinInhibition of Xa factor and thrombin5Not available4000 UI/d or 100 UI/kgSubcutaneous injectionSkin irritation in injection site, bleeding, heparin-induced thrombocytopenia, fatigue, fever[45]NCT04367831
EculizumabMonoclonal antibody which targets C5 inhibiting its cleavage in C5a and C5b3Hydroxychloroquine, lopinavir-ritonavir, ceftriaxone, vitamin C3600 mg/wk (8-22 wk)IntravenousFever, headache, nausea and vomiting, body aches, confusion, increased sensitivity to light, stiffness[32]NCT04288713
Vitamin CAntioxidant, increases the synthesis of norepinephrine and vasopressin, attenuate increases in cytokine levels3All mentioned drugs12 g/12 h (7 d) or 50 mg/kg/6 h (4 d)Oral-intravenousGastrointestinal upset[42-44]NCT04264533