Selected therapies for COVID-19 a

DrugMechanism of actionEvidence, commentsPossible nephrotoxicity
Antiviral therapy
Chloroquine, hydroxychloroquinePrevent 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The emergency use authorization of hydroxychloroquine for severe COVID-19 was revoked in June 2020, as potential risks outweighed the benefits62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
LopinavirritonavirInhibits 3-chymotripsin-like proteaseAntiretroviral 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 favipravirInhibit RNA polymerase and inhibit viral replicationFavipravir is currently being evaluated in clinical trials in the United States
No prospective data to support use of ribavirin
RemdesivirInhibits RNA polymerase and inhibits viral replicationPossible 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
CorticosteroidsDecrease Inflammation and decrease lung injuryUnpublished 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, sarilumabMonoclonal antibodies against interleukin 6 receptor; decrease cytokine stormRepeated 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 immunoglobulinViral antibodies from previously infected and recovered patientsClinical 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.