From the Guidelines
Treatment guidelines for COVID-19 should prioritize corticosteroids for severe cases, with tocilizumab considered for patients with high inflammatory markers, and remdesivir for those receiving oxygen therapy but not on invasive mechanical ventilation (IMV). This approach is based on the most recent and highest quality evidence available, including the study published in Pharmacological Research in 2021 1.
Key Recommendations
- For adult patients with high inflammatory markers, tocilizumab (TCZ) could be considered in addition to corticosteroids 1.
- Remdesivir treatment could be considered for patients receiving oxygen therapy but not on IMV, for a duration of 5 days 1.
- Intravenous immunoglobulin (IVIg) may be considered for patients who fail to respond to initial therapy 1.
- The management of COVID-19 should be tailored to individual patient factors, including age, comorbidities, vaccination status, and disease severity, as highlighted in various studies and guidelines 1.
Disease Severity and Management
- Mild cases can often be managed at home with supportive care, including rest, hydration, and over-the-counter medications for symptom management.
- Severe cases require hospitalization and may involve more intensive interventions, such as oxygen therapy, prone positioning, and in severe cases, mechanical ventilation.
Evolution of Treatment Approaches
Treatment approaches for COVID-19 continue to evolve as new evidence emerges. It is crucial to stay updated with the latest guidelines and research findings to provide the best possible care for patients. The use of antiviral medications, corticosteroids, and other therapies should be guided by the most current and high-quality evidence available.
From the FDA Drug Label
VEKLURY is indicated for the treatment of coronavirus disease 2019 (COVID-19) in adults and pediatric patients (birth to less than 18 years of age weighing at least 1.5 kg) who are [see Clinical Studies (14)]: Hospitalized, or Not hospitalized and have mild-to-moderate COVID-19, and are at high risk for progression to severe COVID-19, including hospitalization or death. The recommended dosage for adults and pediatric patients weighing at least 40 kg is a single loading dose of VEKLURY 200 mg on Day 1 via intravenous infusion followed by once-daily maintenance doses of VEKLURY 100 mg from Day 2 via intravenous infusion. The treatment course of VEKLURY should be initiated as soon as possible after diagnosis of symptomatic COVID-19 has been made. The recommended total treatment duration for hospitalized patients requiring invasive mechanical ventilation and/or extracorporeal membrane oxygenation (ECMO) is 10 days The recommended total treatment duration for hospitalized patients not requiring invasive mechanical ventilation and/or ECMO is 5 days. The recommended total treatment duration for non-hospitalized patients diagnosed with mild-to-moderate COVID-19 who are at high risk for progression to severe COVID-19, including hospitalization or death, is 3 days.
The treatment guidelines for Covid-19 using VEKLURY (remdesivir) are as follows:
- Hospitalized patients:
- Requiring invasive mechanical ventilation and/or ECMO: 10-day treatment course
- Not requiring invasive mechanical ventilation and/or ECMO: 5-day treatment course, which can be extended up to 10 days if no clinical improvement is observed
- Non-hospitalized patients: 3-day treatment course for those with mild-to-moderate COVID-19 who are at high risk for progression to severe COVID-19. The recommended dosage is a single loading dose of 200 mg on Day 1, followed by once-daily maintenance doses of 100 mg from Day 2, via intravenous infusion 2.
From the Research
Overview of Covid-19 Treatment Guidelines
The treatment of Covid-19 is based on the severity of the disease and the patient's underlying health conditions. According to 3, current treatment of Covid-19 patients is essentially based on the administration of supportive oxygen therapy and the use of specific drugs such as steroids, anticoagulants, antivirals, anti-SARS-CoV-2 antibodies, and immunomodulators.
Treatment Options for Covid-19
Several treatment options are being used to treat Covid-19, including:
- Remdesivir, an antiviral agent that works by inhibiting the activity of RNA-dependent RNA polymerase (RdRp) 4, 5
- Baricitinib, a Janus kinase inhibitor, in combination with remdesivir and dexamethasone 6
- Hydroxychloroquine plus azithromycin, which showed excellent clinical efficacy on Chinese COVID-19 patients and anti-SARS-CoV-2 potency in vitro 4
- Lopinavir/ritonavir (LPV/RTV) alone or in combination with ribavirin 4
- Teicoplanin, which inhibits the viral genome exposure in cytoplasm 4
- Monoclonal and polyclonal antibodies 4
Therapeutic Management of Covid-19 Patients
The therapeutic management of Covid-19 patients depends on the severity of the disease and the patient's underlying health conditions. According to 3, the treatment of Covid-19 patients can be categorized into four groups:
- Asymptomatic or mildly/moderate symptomatic patients
- Hospitalized patients requiring low-flow oxygen
- High-flow oxygen
- Mechanical ventilation
Clinical Impact of Combination Therapy
Combination therapy with baricitinib, remdesivir, and dexamethasone has shown promising results in treating severe Covid-19 patients. According to 6, the 28-d mortality rate was low at 2.3% (1/44 patients), and the need for invasive mechanical ventilation was avoided in most patients (90%, 17/19 patients).
Novel Therapeutic Approaches
Novel therapeutic approaches, including mesenchymal stromal cell and immune cell therapy, have shown inspiring results in treating Covid-19. According to 7, immune response modulation and inflammation management can be considered as an essential step in treating Covid-19.