Copyright ©The Author(s) 2021.
World J Virol. Mar 25, 2021; 10(2): 53-61
Published online Mar 25, 2021. doi: 10.5501/wjv.v10.i2.53
Table 1 Current ongoing treatment for coronavirus disease 2019

Rationale of use
SteroidsPrevent and treat acute lung injury and respiratory distress due to host inflammatory response secondary to SARS-CoV-2 infectionMay determine Hyper-glicemia, arterial hypertension
Anticoagulation therapyPrevent and/or treat the over-activation of the coagulation cascade, responsible for ischaemic events and disseminated intravascular coagulationMay determines Hemorrhagic risk
Antiviral agentsProtease inhibitors (lopinavir), nucleotide analogue (remdesivir)May determine Drug/drug interactions, allergic reactions, acquired resistance
Chloroquine/hydroxychloroquineIncreasing in endosomal pH, avoiding the fusion between the virus and the host cell, but also the interference with the ACE2 cell receptor targeted by the virus. immunomodulatory activityMay determine common side effects (nausea, vomiting, diarrhea, abdominal pain, extrapyramidal disorders), and arrhythmogenic cardiotoxicity (thus monitor QT interval)
Oxygen therapyTreatment of hypoxia basically administered through a nasal cannula, face mask or noninvasive CPAP. If an adequate arterial O2 level is not reached (SatO2 < 93%), invasive mechanical ventilation via intubation is necessary. Advanced technique such as prone positioning should be considered as well as extracorporeal membrane oxygenation
Antinflammatory molecules – multiple monoclonal antibodies/immunostimulants (anti IL-17, interferon and mesenchymal stromal cells)Able to reduce inflammation and stimulate regeneration of tissues as well, the amplification of anti-2019nCoV specific T lymphocytes, the employment of anti-Th1-mediated inflammatory cascade such as canakinumab (anti IL-1B) and roflumilast (inhibitor of enzyme phosphodiesterase-4 already used to control neutrophilic inflammation in patients with COPD)
Sartanics (angiotensin receptor 1 blockers)Could be considered for their ability to inhibit the link between the spike S protein of the virus and ACE2According to other studies could predispose to COVID targeting ACE receptors on pulmonary tissue
Some broad spectrum antiviral agents (dsRNA-activated caspase oligomerizer)Cause selective apoptosis of host cells containing virus, this skill could be exploited in fighting COVID-19
Bradykinin receptors B1 and B2 antagonistsCOVID related bradykinin-dependent local lung angioedema
PlasmaPassive immunotherapy
Table 2 Primary and secondary outcomes of studies included in simmons’ meta-analysis

Intervention arm (92 patients)
Control arm (84 patients)
OutcomesPrimaryClinical recovery in 14 d86 (93%)57 (68%)
All cause mortality5 (5%)17 (20%)
SecondaryDuration of hospitalization6 (IQR: 5-7)8 (IQR: 6-11)
ICU admission/imv needed9 (10%)24 (29%)
Table 3 Therapeutic schedule of clinical trials considered in meta-analysis

Disease stage
Treatment arm
Control arm
EslamiSevere35 patients: SOC (lopinavir/ritonavir + hydroxychloroquine) + Sof/dac started 24-48 h later (after PCR and TC confirmation of COVID-19)27 patients: SOC (lopinavir/ritonavir + hydroxychloroquine) + ribavirin14 d
KasgariModerate24 patients: Sof/dac + ribavirin24 patients: Lopinavir/ritonavir + hydroxychloroquine ± Ribavirin 6 d?
Sadeghisevere33 patients: Sof/dac + lopinavir/ritonavir33 patients: Lopinavir/ritonavir14 d