Emerging pharmacotherapy for COVID-19.

Broadly speaking, pharmacological treatments for COVID-19 can be divided into those acting on upstream pathways early on in the disease process via suppression of viral replication or by inhibiting cell entry, and those acting on downstream pathways later on via selective attenuation of the adaptive immune cytokine-mediated inflammatory response. The antiviral drug remdesivir has been shown to shorten duration of disease while interferon beta-1b may speed up viral clearance. The results with hydroxychloroquine have thus far been rather disappointing. Trials with selective cytokine blockers including anti-interleukin-1 (anti-IL-1) and anti-interleukin-6 (anti-IL-6), have shown some promise in more severe cases, with further confirmation being required from large-scale phase-3 randomised controlled trials. The likelihood is that combination therapy addressing both upstream and downstream pathways may be required to prevent progression of severe COVID-19 infection in susceptible older patients with comorbidities and we believe further studies are now warranted to specifically target such at-risk groups who are more prone to worse outcomes.

Déclaration de conflit d'intérêts

Dr Kuo reports personal fees from AstraZeneca, personal fees from Chiesi, personal fees from Circassia, outside the submitted work. Dr Lipworth reports no competing interests with respect to the submitted work, and reports personal fees and non-financial support from AstraZeneca, grants, personal fees and non-financial support from Chiesi and Sanofi, personal fees from Cipla, Novartis, Lupin and Dr Reddys, from Glenmark, grants and personal fees from Teva and Mylan, personal fees from Vectura, outside the submitted work; Dr Lipworth’s son is an employee of AstraZeneca.