What are the medications for Coronavirus disease (COVID-19)?

From the Guidelines

For COVID-19 treatment, the most effective medication regimen should prioritize reducing morbidity, mortality, and improving quality of life, with Paxlovid (nirmatrelvir/ritonavir) being considered for high-risk patients, and remdesivir or dexamethasone for specific cases, as supported by recent studies 1.

Treatment Options

• Paxlovid (nirmatrelvir/ritonavir) is considered for high-risk patients, taken as 300mg nirmatrelvir with 100mg ritonavir twice daily for 5 days, started within 5 days of symptom onset.
• Remdesivir is an alternative, given intravenously as 200mg on day 1, then 100mg daily for 2 more days, particularly for patients with severe COVID-19, as suggested by the living WHO guideline 1.
• For hospitalized patients requiring oxygen, dexamethasone 6mg daily for up to 10 days is recommended, as it reduces harmful inflammatory responses and has been shown to decrease mortality in combination with other therapies 1.

Considerations

• Treatment choice depends on risk factors (age over 65, immunocompromise, chronic conditions), timing of infection, and medication availability.
• Drug interactions must be considered with Paxlovid, and all treatments should be prescribed by healthcare providers after individual assessment.
• The use of Janus kinase inhibitors (baricitinib and tofacitinib) is promising in severe and critical COVID-19, particularly in combination with glucocorticoids, as they may decrease disease progression and mortality 1.

Mechanisms and Outcomes

• These medications work by different mechanisms: Paxlovid inhibits viral replication enzymes, remdesivir interferes with viral RNA production, and dexamethasone reduces harmful inflammatory responses.
• The goal of treatment is to reduce morbidity, mortality, and improve quality of life, with the choice of medication depending on the individual patient's needs and the severity of their condition, as informed by the latest evidence 1.

From the FDA Drug Label

1.7 Coronavirus Disease 2019 (COVID-19) ACTEMRA® (tocilizumab) is indicated for the treatment of coronavirus disease 2019 (COVID-19) in hospitalized adult patients who are receiving systemic corticosteroids and require supplemental oxygen, non-invasive or invasive mechanical ventilation, or extracorporeal membrane oxygenation (ECMO).

Tocilizumab (IV) is indicated for the treatment of COVID-19 in hospitalized adult patients who are receiving systemic corticosteroids and require supplemental oxygen, non-invasive or invasive mechanical ventilation, or extracorporeal membrane oxygenation (ECMO) 2.

• The medication is used for hospitalized adult patients with COVID-19.
• Patients should be receiving systemic corticosteroids.
• Patients should require supplemental oxygen, non-invasive or invasive mechanical ventilation, or ECMO.

From the Research

Covid Medication Overview

• Covid-19 is an infectious disease of global importance, and various medications have been developed to treat it.
• Remdesivir is a broad-spectrum antiviral that was the first US Food and Drug Administration-approved treatment for COVID-19 3.
• It is recommended for hospitalized patients with COVID-19, with or without a supplemental oxygen requirement, as well as for nonhospitalized patients with COVID-19 who are at high risk of progression to severe disease 3.

Treatment Options

• Remdesivir has been shown to improve survival and disease progression in patients with COVID-19 across a spectrum of disease severity and SARS-CoV-2 variant periods 3.
• Combination therapy with baricitinib, remdesivir, and dexamethasone has been effective in treating severe COVID-19, with a low incidence rate of adverse events 4.
• Baricitinib and dexamethasone can be used as an alternative to remdesivir, but further trials are needed to determine their superiority or whether they should be used together 5.

Safety and Efficacy

• A study on the safety and efficacy of combination therapy with remdesivir, baricitinib, and high-dose steroids in patients hospitalized with moderate to severe COVID-19 showed a low frequency of high-grade adverse events, except for hyperglycemia 6.
• The median time to improvement by 1 category of the eight-category ordinal score was 6 days, and the 28-day mortality was 0.9% in patients treated with the combination therapy 6.
• Remdesivir has been shown to be effective in patients with severe COVID-19, with a clinical improvement of 2 points or more on the ordinal scale occurring in 64% of patients in the 5-day group and in 54% in the 10-day group 7.