Coronavirus Disease 2019 Treatment: A Review of Early and Emerging Options

McCreary, Erin K; Pogue, Jason M

On behalf of the Society of Infectious Diseases Pharmacists, we herein summarize the current evidence as of March 19, 2020 to provide guidance on potential COVID-19 treatment options. It is important to caution readers that new data emerges approximately every hour regarding clinical characteristics, treatment options, and outcomes for COVID-19. Optimized supportive care remains the mainstay of therapy, and the clinical efficacy for the subsequent agents is still under investigation. Most existing preclinical and clinical data on antiviral therapy are derived from other viruses, including SARS-CoV-1 (first reported in 2003), Middle East respiratory syndrome coronavirus ([MERS-CoV] first reported in 2012), and non-coronaviruses (eg, Ebola virus disease). It is unclear how well these data can be extrapolated to SARS-CoV-2. Furthermore, the clinical relevance of antiviral in vitro activity (defined as half-maximal effective concentration [EC 50 ] values) remains unclear given an absence of pharmacokinetic/pharmacodynamic or clinical data that equates achievable exposures relative to these values to a treatment effect. Finally, in vitro data should be compared cautiously across studies given the potential variability in testing methodologies that could impact perceived activity.