Antiviral Drugs That Are Under Evaluation for the Treatment of COVID-19
Last Updated: October 9, 2020
There are no Food and Drug Administration-approved drugs for the treatment of COVID-19. In this section, the COVID-19 Treatment Guidelines Panel (the Panel) provides recommendations for using antiviral drugs to treat COVID-19 based on the available data. As in the management of any disease, treatment decisions ultimately reside with the patient and their health care provider.
For more information on the antiviral agents that are currently being evaluated for the treatment of COVID-19, see Table 2.
The Remdesivir section of the Guidelines will be updated soon. See Therapeutic Management of Patients with COVID-19 for recommendations on using remdesivir with or without corticosteroids.
Recommendation for Prioritizing Limited Supplies of Remdesivir
Recommendation for Patients With Mild or Moderate COVID-19
Recommendations for Patients with COVID-19 Who Require Supplemental Oxygen
For Patients Who Do Not Require Oxygen Delivery Through a High-Flow Device, Noninvasive Ventilation, Invasive Mechanical Ventilation, or ECMO
For Patients Who Require Oxygen Delivery Through a High-Flow Device, Noninvasive Ventilation, Invasive Mechanical Ventilation, or ECMO
Duration of Therapy for Patients Who Have Not Shown Clinical Improvement After 5 Days of Therapy
Chloroquine or Hydroxychloroquine With or Without Azithromycin
Lopinavir/Ritonavir and Other HIV Protease Inhibitors
Rating of Recommendations: A = Strong; B = Moderate; C = Optional
Rating of Evidence: I = One or more randomized trials with clinical outcomes and/or validated laboratory endpoints; II = One or more well-designed, nonrandomized trials or observational cohort studies; III = Expert opinion
Because severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) replication leads to many of the clinical manifestations of COVID-19, antiviral therapies are being investigated for the treatment of COVID-19. These drugs inhibit viral entry (via the angiotensin-converting enzyme 2 [ACE2] receptor and transmembrane serine protease 2 [TMPRSS2]), viral membrane fusion and endocytosis, or the activity of the SARS-CoV-2 3-chymotrypsin-like protease (3CLpro) and the RNA-dependent RNA polymerase.1 Because viral replication may be particularly active early in the course of COVID-19, antiviral therapy may have the greatest impact before the illness progresses into the hyperinflammatory state that can characterize the later stages of disease, including critical illness.2 For this reason, it is necessary to understand the role of antivirals in treating mild, moderate, severe, and critical illness in order to optimize treatment for people with COVID-19.
The following sections describe the underlying rationale for using different antiviral medications, provide the Panel’s recommendations for using these medications to treat COVID-19, and summarize the existing clinical trial data. Additional antiviral therapies will be added to this section of the Guidelines as new evidence emerges.
- Sanders JM, Monogue ML, Jodlowski TZ, Cutrell JB. Pharmacologic treatments for coronavirus disease 2019 (COVID-19): a review. JAMA. 2020;323(18):1824-1836. Available at: https://www.ncbi.nlm.nih.gov/pubmed/32282022.
- Siddiqi HK, Mehra MR. COVID-19 illness in native and immunosuppressed states: a clinical-therapeutic staging proposal. J Heart Lung Transplant. 2020;39(5):405-407. Available at: https://www.ncbi.nlm.nih.gov/pubmed/32362390.