An overview of treatment options for COVID-19

Madhusmita Mohanty Mohapatra, Manju Rajaram, Dharm Prakash Dwivedi, Vishnukant Govindraj, Pratap Upadhya


Severe acute respiratory syndrome- coronavirus-2 (SARS-CoV-2) which emerged in Wuhan initially as pneumonia of unknown origin in December 2019, later spread to whole world and became pandemic on 11th March, 2020. Many drugs have been proposed but are backed without clinical evidence. Scientific bodies are in the row to discover a reliable vaccine and effective drugs against the novel coronavirus. Many antiviral and anti-parasitic drugs which were thought to have some effect on Coronavirus disease 2019 (COVID-19) have been tried during the crisis but none have shown concrete evidence of action. Randomized clinical trials on the repurposed drugs are now registered under clinical trial registry to look at the safety profile and efficacy of the drugs to be used against SARS-CoV-2. Many meta-analyses are being conducted worldwide to frame evidence for the fight against this novel coronavirus. We are providing below a review of various drugs that have been tried for treatment of COVID-19 as well as different clinical trials which are underway.


Antivirals, Convalescent plasma therapy, COVID-19, Immunosuppressant, Mesenchymal cell

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COVID-19 cases worldwide. 2020. Available at: Accessed on 22 June 2020.

Zhou P. A pneumonia outbreak associated with a new coronavirus of probable bat origin. Nature. 2020;579:270-3.

Xia S. Inhibition of SARS-CoV-2 (previously 2019-nCoV). Cell Res. 2020;30(4):343-55.

Batlle D, Wysocki J, Satchell K. Soluble angiotensinconverting enzyme 2: A potential approach for coronavirus infection therapy? Clin Sci (Lond). 2020;134:543-45.

Colson P, Rolain JM, Raoult D. Chloroquine for the 2019 novel coronavirus SARS-CoV-2. Int J Antimicrob Agents. 2020;55:105923.

Gao J, Tian Z, Yang X. Breakthrough: chloroquine phosphate has shown apparent efficacy in treatment of COVID-19 associated pneumonia in clinical studies. Biosci Trends. 2020;14(1):72-3.

Schrezenmeier E, Dörner T. Mechanisms of action of hydroxychloroquine and chloroquine: implications for rheumatology. Nat Rev Rheumatol. 2020;16:155-66.

Cao B, Wang Y, Wen D. A Trial of Lopinavir-Ritonavir in Adults Hospitalized with Severe Covid-19. N Engl J Med. 2020;382(19):1787‐99.

Chen Q, Quan B, Li X. A report of clinical diagnosis and treatment of nine cases of coronavirus disease 2019. J Med Virol. 2020;10.1002/jmv.25755.

Grein J, Ohmagari N, Shin D. Compassionate Use of Remdesivir for Patients with Severe Covid-19. N Engl J Med. 2020;NEJMoa2007016.

Guan WJ, Ni ZY, Hu Y, Liang WH, Ou CQ, He JX, et al. Clinical Characteristics of Coronavirus Disease 2019 in China. The New England journal of medicine. 2020;382:1708-20.

Bethesda. A prospective, randomized controlled clinical study of antiviral therapy in the 2019-nCoV pneumonia. (MD): National Library of Medicine (US). Identifier NCT04255017. 2020. Available at: ct2/show/NCT04255017?term=antiviral+therapy&cond=Covid19&draw=2. Accessed on 10 August 2020.

Bethesda. The efficacy of lopinavir plus ritonavir and arbidol against novel coronavirus infection (ELACOI). National Library of Medicine (US). 2020. Identifier NCT04252885. Available at: /NCT04252885. Accessed on 10 August, 2020.

Bethesda. The clinical study of carrimycin on treatment patients with Covid19. National Library of Medicine (US). 2020. Identifier NCT04286503. Available at: https://clinicaltrials. gov/ct2/show/ NCT04286503. Accessed on 10 August, 2020.

Bethesda. A Randomised Controlled Trial of Early Intervention in COVID-19: Favipiravir Verses HydroxycholorquiNe & Azithromycin & Zinc vErsEs Standard CaRe (PIONEER). National Library of Medicine (US). 2020. Identifier NCT04373733. Available at: https://clinicaltrials. gov/c2/show/NCT04373733. Accessed on 10 August, 2020.

Clinical study for safety and efficacy of Favipiravir in the treatment of novel coronavirus pneumonia (COVID-19). Chinese Clinical trial registry. 2020. Identifier- ChiCTR2000029600. Available at: https:// ChiCTR2000029600. Accessed on 10 August, 2020.

Yousefifard M, Zali A, Mohamed Ali K, Madani Neishaboori A, Zarghi A, Hosseini M et al. Antiviral therapy in management of COVID-19: a systematic review on current evidence. Arch Acad Emerg Med. 2020;8(1):e45.

Gao J, Tian Z, Yang X. Breakthrough: chloroquine phosphate has shown apparent efficacy in treatment of COVID-19 associated pneumonia in clinical studies. Biosci Trends. 2020;14(1):72-3.

Cortegiani A, Ingoglia G, Ippolito M, Giarratano A, Einav S. A systematic review on the efficacy and safety of chloroquine for the treatment of COVID-19. J Crit Care. 2020;57:279-83.

Liu J, Cao R, Xu M, Wang X, Zhang H, Hu H, et al. Hydroxychloroquine, a less toxic derivative of chloroquine, is effective in inhibiting SARS-CoV-2 infection in vitro. Cell Discov. 2020;6:16.

Chen J, Liu D, Liu L. A pilot study of hydroxychloroquine in treatment of patients with common coronavirus disease-19 (COVID-19). Journal of Zhe Jiang University (Medical Sciences). 2020;49(2):215-9.

Gautret P, Lagier J-C, Parola P. Hydroxychloroquine and azithromycin as a treatment of COVID-19: results of an open- label non- randomized clinical trial. Int J Antimicrob Agents. 2020;105949:105949.

Sarma P, Kaur H, Kumar H. Virological and clinical cure in COVID‐19 patients treated with hydroxychloroquine: a systematic review and meta‐analysis. J Med Virol. 2020;92(7):776-85.

Singh AK, Singh A, Singh R, Misra A. Hydroxychloroquine in patients with COVID-19: A Systematic Review and meta-analysis. Diabetes Metab Syndr. 2020;14(4):589-96.

Caly L, Druce JD, Catton MG, Jans DA, Wagstaff KM. The FDA-approved drug ivermectin inhibits the replication of SARS-CoV-2 in vitro. Antiviral Res. 2020;178:104787.

Kelleni MT, Nitazoxanide/Azithromycin combination for COVID-19: A suggested new protocol for COVID-19 early management. Pharmacological Res. 2020;157:104874.

Damle B, Vourvahis M, Wang E, Leaney J, Corrigan B. Clinical Pharmacology Perspectives on the Antiviral Activity of Azithromycin and Use in COVID-19. Clin Pharmacol Ther. 2020;10.1002/cpt.1857.

Bethesda. Randomized Comparison of Combination Azithromycin and Hydroxychloroquine vs. Hydroxychloroquine Alone for the Treatment of Confirmed COVID-19. National Library of Medicine (US). 2020. Identifier NCT04336332.

Bethesda. Hydroxychloroquine Plus Azithromycin Versus Hydroxychloroquine for COVID-19 Pneumonia (COVIDOC Trial) (COVIDOC). National Library of Medicine (US). 2020. Identifier NCT04345861.

Valuation the Effect of Ticoplanin in Patients With Coronavirus Disease. World Health Organization Database on clinical trials. Identifier IRCT20161204031229N3. Accessed on 27 May, 2020.

Rajendran K, Krishnasamy N, Rangarajan J, Rathinam J, Natarajan M, Ramachandran A. Convalescent plasma transfusion for the treatment of COVID-19: Systematic review. J Med Virol. 2020;10:1002/jmv.25961.

Bethesda. Convalescent Plasma as Therapy for Covid-19 Severe SARS-CoV-2 Disease (CONCOVID Study) (ConCoVid-19). National Library of Medicine (US). 2020. Identifier NCT04342182.

Tang N, Bai H, Chen X, Gong J, Li D, Sun Z. Anticoagulant treatment is associated with decreased mortality in severe coronavirus disease 2019 patients with coagulopathy. J Thromb Haemost. 2020;18(5):1094-99.

Cui S, Chen S, Li X, Liu S, Wang F. Prevalence of venous thromboembolism in patients with severe novel coronavirus pneumonia. J Thromb Haemost. 2020;18(6):1421-24.

Klok FA, Kruip MJHA, van der Meer NJM. Incidence of thrombotic complications in critically ill ICU patients with COVID-19. Thromb Res. 2020;S0049-3848(20)30120-1.

World Health Organization. Clinical management of severe acute respiratory infection when COVID-19 is suspected 2020. Available at: https://www.who. int/publications-detail/clinicalmanagement-of-severe-acute-respiratory-infection-when-novel-coronavirus-(ncov)-infection-is-suspected. Accessed 28 May, 2020.

Thachil J, Tang N, Gando S, Falanga A, Cattaneo M, Levi M, et al. ISTH interim guidance on recognition and management of coagulopathy in COVID-19. J Thromb Haemost. 2020;18(5):1023-6.

Bethesda. Coagulopathy of COVID-19: A Pragmatic Randomized Controlled Trial of Therapeutic Anticoagulation Versus Standard Care. National Library of Medicine (US). 2020. Identifier NCT04362085.

Bethesda. A Randomized Trial of Anticoagulation Strategies in COVID-19. Bethesda (MD): National Library of Medicine (US). 2020. Identifier NCT04359277.

Lu S, Zhou Q, Huang L, Shi Q, Zhao S, Wang Z, et al. Effectiveness and Safety of Glucocorticoids to Treat COVID-19: A Rapid Review and Meta-Analysis. medrxiv. 2020;04(17):20064469.

Tobaiqy M, Qashqary M, Al-Dahery S, Mujallad A, Hershan AA, Kamal MA et al. Therapeutic management of patients with COVID-19: a systematic review. Infection Prevention in Practice. 2020;100061.

Horby P, Lim WS, Emberson J. Effect of dexamethasone in hospitalized patients with covid-19: preliminary report. MedRxiv. 2020.

Xu X, Han M, Li T, Sun W, Wang D, Fu B, et al. Effective treatment of severe COVID-19 patients with tocilizumab. Proc Natl Acad Sci U S A. 2020;117(20):10970-5.

Roumier M, Paule R, Groh M, Vallee A, Ackermann F. Interleukin-6 blockade for severe COVID-19. medrxiv. 2020;04(20):20061861.

Bethesda. Tocilizumab in COVID-19 Pneumonia (TOCIVID-19). National Library of Medicine (US). 2020. Identifier NCT04317092.

Bethesda. Sirolimus Treatment in Hospitalized Patients With COVID-19 Pneumonia (SCOPE). National Library of Medicine (US). 2020. Identifier NCT04341675.

Zhou Y, Hou Y, Shen J, Huang Y, Martin W, Cheng F. Networkbased drug repurposing for novel coronavirus 2019-nCoV/SARSCoV-2. Cell Discov. 2020;6:14.

Hung IF, Lung KC, Tso EY, Liu R, Chung TW, Chu MY et al. Triple combination of interferon beta-1b, lopinavir-ritonavir, and ribavirin in the treatment of patients admitted to hospital with COVID-19: an open-label, randomised, phase 2 trial. Lancet. 2020;S0140-6736(20)31042-4.

Leng Z, Zhu R, Hou W, Feng Y, Yang Y, Han Q, et al. Transplantation of ACE2- Mesenchymal stem cells improves the outcome of patients with COVID-19 pneumonia. Aging Dis. 2020;11(2):216-28.

Bethesda. Clinical Research of Human Mesenchymal Stem Cells in the Treatment of COVID-19 Pneumonia. National Library of Medicine (US). 2020. Identifier NCT04339660.

Bethesda. A Double-blind, Placebo-controlled Clinical Trial of Fluvoxamine for Symptomatic Individuals With COVID-19 Infection (STOP COVID). National Library of Medicine (US). 2020. Identifier NCT04342663. Available at: NCT04342663?term=fluvoxamine&cond=Covid19&draw=2&rank=1.Accessed on 10 August 2020.

Bethesda. Vitamin C Infusion for the Treatment of Severe 2019-nCoV Infected Pneumonia. National Library of Medicine (US). 2020. Identifier NCT04264533.

Bethesda. Nitric Oxide Gas Inhalation Therapy for Mild/Moderate COVID-19 (NoCovid). National Library of Medicine (US). 2020. Identifier NCT04305457. Available at: Accessed on 10 August 2020.

Bethesda. NO Prevention of COVID-19 for Healthcare Providers (NOpreventCOVID). National Library of Medicine (US). 2020. Identifier NCT04312243.

Ang L, Song E, Lee HW, Lee MS. Herbal Medicine for the Treatment of Coronavirus Disease 2019 (COVID-19): A Systematic Review and Meta-Analysis of Randomized Controlled Trials. J Clin Med. 2020;9(5):E1583.

Bethesda. Clinical Trial of Mycobacterium w in Critically Ill COVID 19 Patients. National Library of Medicine (US). 2020. Identifier NCT04347174.

Ruan Q, Yang K, Wang W, Jiang L, Song J. Clinical predictors of mortality due to COVID-19 based on an analysis of data of 150 patients from Wuhan, China. Intensive Care Med. 2020;46(5):846-8.

Deftereos SG, Siasos G, Giannopoulos G, Vrachatis DA, Angelidis C, Giotaki SG et al. The Greek study in the effects of colchicine in COvid-19 complications prevention (GRECCO-19 study): Rationale and study design. Hellenic J Cardiol. 2020;61(1):42-5.

Bethesda. Intravenous Aviptadil for Critical COVID-19 With Respiratory Failure (COVID-AIV). National Library of Medicine (US). 2020. Identifier NCT04311697. Available at: Accessed on 10 August 2020.

Bethesda. Safety, Tolerability, and Efficacy of Anti-Spike (S) SARS-CoV-2 Monoclonal Antibodies for Hospitalized Adult Patients With COVID-19. National Library of Medicine (US). 2020. Identifier NCT04426695. Available at: Accessed on 10 August 2020.