Selected therapies for COVID-19 a
| Drug | Mechanism of action | Evidence, comments | Possible nephrotoxicity |
|---|---|---|---|
| Antiviral therapy | |||
| Chloroquine, hydroxychloroquine | Prevent glycosylation of host receptors and inhibit viral entry into host cells Immunomodulatory effect through inhibiting cytokine production | Initially thought to improve viral clearance and disease duration60,61 but evidence is increasingly unsupportive The emergency use authorization of hydroxychloroquine for severe COVID-19 was revoked in June 2020, as potential risks outweighed the benefits62 | Podocytopathy of the kidney mimicking Fabry disease (rare)57 |
| Lopinavirritonavir | Inhibits 3-chymotripsin-like protease | Antiretroviral combination drug approved for treatment of human immunodefi ciency virus infection No difference in viral clearance, mortality63 No benefit for patients with severe COVID-19 compared with standard care63 | Reversible acute kidney injury57 |
| Ribavirin and favipravir | Inhibit RNA polymerase and inhibit viral replication | Favipravir is currently being evaluated in clinical trials in the United States No prospective data to support use of ribavirin | |
| Remdesivir | Inhibits RNA polymerase and inhibits viral replication | Possible improvement in oxygen support status in severe COVID-19 with remdesivir58 Use of remdesivir in COVID-19 patients was associated with shortened time to recovery, but overall 14-day mortality rate was not significantly different compared with placebo66 Emergency use authorization issued for use in severe COVID-19 and recently expanded use to include all hospitalized patients with COVID-19 regardless of severity.56,57 | Potential mitochondrial toxicity with remdesivir57 |
| Immunomodulatory and anti-inflammatory therapy | |||
| Corticosteroids | Decrease Inflammation and decrease lung injury | Unpublished analysis from the United Kingdom showed a reduction in 28-day mortality rate in patients with severe COVID-19 on mechanical ventilation with the use of dexamethasone65 | |
| Tocilizumab, sarilumab | Monoclonal antibodies against interleukin 6 receptor; decrease cytokine storm | Repeated doses of tocilizumab may be required to decrease interleukin 6 levels7,59 Tocilizumab is recommended by the Infectious Diseases Society of America only in the context of a clinical trial72 | |
| Convalescent plasma, intravenous immunoglobulin | Viral antibodies from previously infected and recovered patients | Clinical improvement in 5 critically ill patients with COVID-1968 High-dose intravenous immunoglobulin reportedly effective in case series with severe COVID-1969 Convalescent plasma has been granted emergency use authorization for hospitalized patients with COVID-19.58 | Proximal tubular injury with intravenous immunoglobulin69 |
↵a This information is current at the time of this publication but may change as new findings are published.