Potential Antiviral Drugs Under Evaluation for the Treatment of COVID-19

There are no Food and Drug Administration (FDA)-approved drugs for the treatment of COVID-19. Although reports have appeared in the medical literature and the lay press claiming successful treatment of patients with COVID-19 with a variety of agents, definitive clinical trial data are needed to identify safe and effective treatments for this disease. Recommended clinical management of patients with COVID-19 includes infection prevention and control measures and supportive care, including supplemental oxygen and mechanical ventilatory support when indicated. As in the management of any disease, treatment decisions ultimately reside with the patient and their health care provider.

Antivirals:

• On the basis of preliminary clinical trial data, the COVID-19 Treatment Guidelines Panel (the Panel) recommends the investigational antiviral agent remdesivir for the treatment of COVID-19 in hospitalized patients with severe disease defined as SpO2 ≤94% on ambient air (at sea level), requiring supplemental oxygen, mechanical ventilation, or extracorporeal membrane oxygenation (BI).
  • Remdesivir is not approved by the FDA. It is available through an FDA emergency use authorization, in clinical trials, or through an emergency access program for children and pregnant patients.
• The Panel does not recommend remdesivir for the treatment of mild or moderate COVID-19 outside of a clinical trial (AIII).

• There are insufficient clinical data to recommend either for or against using chloroquine or hydroxychloroquine for the treatment of COVID-19 (AIII).
• The Panel recommends against using high-dose chloroquine (600 mg twice daily for 10 days) for the treatment of COVID-19 (AI).
• Except in the context of a clinical trial, the Panel recommends against the use of the following drugs for the treatment of COVID-19:
  • The combination of hydroxychloroquine plus azithromycin (AIII) because of the potential for toxicities.
  • Lopinavir/ritonavir (AI) or other HIV protease inhibitors (AIII) because of unfavorable pharmacodynamics and negative clinical trial data.