Pharmacological treatment of COVID-19: lights and shadows

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Francesco Menzella MD, Mirella Biava Msc, Chiara Barbieri MD, Francesco Livrieri MD, Nicola Facciolongo MD

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At the end of December 2019, a novel coronavirus, the severe acute respiratory syndrome coronavirus 2, caused an outbreak of pneumonia spreading from Wuhan, Hubei province, to the whole country of China and then the entire world, forcing the World Health Organization to make the assessment that the coronavirus disease (COVID-19) can be characterized as a pandemic, the first ever caused by a coronavirus. To date, clinical evidence and guidelines based on reliable data and randomized clinical trials for the treatment of COVID-19 are lacking. In the absence of definitive management protocols, many treatments for COVID-19 are currently being evaluated and tested worldwide. Some of these options were soon abandoned due to ineffectiveness, while others showed promising results. The basic treatments are mainly represented by antiviral drugs, even if the evidence is not satisfactory. Among the antivirals, the most promising appears to be remdesivir. Corticosteroids and tocilizumab seem to guarantee positive results in selected patients so far, although the timing of starting therapy and the most appropriate therapeutic schemes remain to be clarified. Efficacy of the other drugs is still uncertain, and they are currently used as a cocktail of treatments in the absence of definitive guidelines. What will represent the real solution to the enormous problem taking place worldwide is the identification of a safe and effective vaccine, for which enormous efforts and investments are underway.

Keywords: antivirals, biologics, coronavirus, corticosteroids, pneumonia, severe acute respiratory syndrome.

Citation: Menzella F, Biava M, Barbieri C, Livrieri F, Facciolongo N. Pharmacological treatment of COVID-19: lights and shadows. Drugs in Context 2020; 9: 2020-4-6. DOI: 10.7573/dic.2020-4-6

Contributions: FM and MB conceived the manuscript outline, contributed to all the sections, and revised the whole manuscript. CB and FL drafted the paragraphs concerning antibiotics and anticoagulants. NF reviewed and approved the manuscript. All the authors read and approved the final version. All named authors meet the International Committee of Medical Journal Editors (ICMJE) criteria for authorship for this article, take responsibility for the integrity of the work as a whole, and have given their approval for this version to be published.

Disclosure and potential conflicts of interest: Francesco Menzella participated in contracted research and clinical trials for Novartis and Sanofi. He has received lecture fees and advisory board fees from AstraZeneca, Boehringer Ingelheim, Chiesi, GlaxoSmithKline, Mundipharma, and Novartis. The other authors report no conflicts of interest in this work. The International Committee of Medical Journal Editors (ICMJE) Potential Conflicts of Interests form for the authors is available for download at:

Acknowledgements: None.

Funding declaration: There was no funding associated with the preparation of this article.

Copyright: Copyright © 2020 Menzella F, Biava M, Barbieri C, Livrieri F, Facciolongo N. Published by Drugs in Context under Creative Commons License Deed CC BY NC ND 4.0 which allows anyone to copy, distribute, and transmit the article provided it is properly attributed in the manner specified below. No commercial use without permission.

Correct attribution: Copyright © 2020 Menzella F, Biava M, Barbieri C, Livrieri F, Facciolongo N. Published by Drugs in Context under Creative Commons License Deed CC BY NC ND 4.0.

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Correspondence: Francesco Menzella, Department of Medical Specialties, Pneumology Unit, Azienda USL di Reggio Emilia- IRCCS, Viale Amendola 2, 42122 Reggio Emilia, Italy.

Provenance: submitted; externally peer reviewed.

Submitted: 13 April 2020; Peer review comments to author: 30 April 2020; Revised manuscript received: 30 April 2020; Accepted: 30 April 2020; Publication date: 19 May 2020.

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