What alternative medications can be used to treat Coronavirus disease (COVID-19)?

From the Guidelines

For the treatment of COVID-19, the use of dexamethasone, baricitinib, and tocilizumab is recommended for hospitalized patients requiring oxygen, as these medications have shown mortality benefits by reducing inflammatory damage 1, 2. The choice of medication depends on the severity of illness and individual patient factors. For mild to moderate COVID-19 in high-risk outpatients, antiviral medications such as nirmatrelvir-ritonavir (Paxlovid) or remdesivir may be considered, with the goal of preventing viral replication and reducing the risk of disease progression. In patients with COVID-19 requiring oxygen therapy, non-invasive ventilation, or high-flow oxygen, the combination of glucocorticoids and baricitinib or tofacitinib could be considered to decrease disease progression and mortality 1, 2. Some key points to consider when selecting alternative medications for COVID-19 treatment include:

• The use of corticosteroids, such as dexamethasone, is recommended for the treatment of severe COVID-19, as they have been shown to reduce mortality 3, 4.
• The addition of tocilizumab or baricitinib to glucocorticoids may be considered for patients with increasing oxygen requirements despite steroids, as these medications have been shown to reduce disease progression and mortality 1, 2.
• Remdesivir may be considered for patients who fail to respond to initial therapy, although the evidence for its use is moderate 4.
• Monoclonal antibody treatments have largely lost effectiveness against current variants and are not recommended as a first-line treatment for COVID-19. It is essential to note that the treatment of COVID-19 should be individualized, and the choice of medication should be based on the patient's specific needs and medical history.

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).

What is VEKLURY? VEKLURY is a prescription medicine used for the treatment of coronavirus disease 2019 (COVID-19) in adults and children weighing at least 3 pounds (1. 5 kg) who are: 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.

Alternative medications for COVID-19 treatment include:

• Tocilizumab (IV) 5, hospitalized adult patients receiving systemic corticosteroids and requiring supplemental oxygen, non-invasive or invasive mechanical ventilation, or extracorporeal membrane oxygenation (ECMO)
• Remdesivir (PO) hospitalized or non-hospitalized patients with mild-to-moderate COVID-19 who are at high risk for progression to severe COVID-19

From the Research

Alternative Medications for COVID-19

The following alternative medications can be used to treat Coronavirus disease (COVID-19):

• Remdesivir: an antiviral agent approved for the treatment of COVID-19, which has been shown to reduce recovery time, improve clinical outcomes, and decrease mortality 8, 9, 10, 11, 12
• Corticosteroids: such as dexamethasone, which have demonstrated mortality benefits in large, randomized controlled trials and are recommended for use in hospitalized patients with severe or critical COVID-19 8, 10, 12
• Tocilizumab: an immunomodulatory agent that has been shown to be effective in reducing mortality and improving clinical outcomes in certain hospitalized patients with COVID-19 8, 9, 10, 11, 12
• Monoclonal antibody combinations: such as bamlanivimab/etesevimab and casirivimab/imdevimab, which have received emergency use authorizations for use in non-hospitalized patients with mild-to-moderate COVID-19 at high risk of disease progression 8
• Baricitinib: an immunomodulatory agent that has been shown to reduce intensive care unit admission and mortality in patients with COVID-19 10
• Anakinra: an immunomodulatory agent that has been shown to reduce mortality in patients with COVID-19 10
• Lopinavir/ritonavir: an antiviral agent that has been investigated for the treatment of COVID-19, but its efficacy is still uncertain 9, 10, 11
• Hydroxychloroquine: an antiviral agent that has been investigated for the treatment of COVID-19, but its efficacy is still uncertain 9, 10, 11
• Favipiravir: an antiviral agent that has been investigated for the treatment of COVID-19, but its efficacy is still uncertain 9, 10, 11
• Ivermectin: an antiviral agent that has been investigated for the treatment of COVID-19, but its efficacy is still uncertain 9

Treatment Considerations

The choice of treatment for COVID-19 depends on the severity of the disease and the patient's individual needs. Antiviral agents, such as remdesivir, are most effective when administered early in the course of the disease, while immunomodulatory agents, such as tocilizumab and corticosteroids, may be more effective in patients with severe or critical disease 8, 9, 10, 11, 12.