Drug Treatment for COVID-19: A Quick Summary for PCPs

Laurie Scudder, DNP, NP

Disclosures

July 15, 2020

Find the latest COVID-19 news and guidance in Medscape's Coronavirus Resource Center.

Information about COVID has evolved so quickly that it can be difficult for clinicians to feel confident that they are staying current. These summaries include links to our COVID-19 FAQ, which is constantly updated to make sure you have the latest information.

While treatment for COVID-19 outside of the hospital setting is currently limited to supportive therapy, over 1000 clinical trials are underway looking at a range of drug treatments. Here is a quick summary for primary care clinicians of the current state of evidence.

Remdesivir

Much-anticipated results from the National Institute of Allergy and Infectious Diseases' clinical trial of remdesivir, published in May, confirmed preliminary results suggesting that the drug shortens the disease course for hospitalized COVID-19 patients. That earlier report resulted in the US Food and Drug Administration (FDA) issuing an emergency use authorization for the drug. Drugmaker Gilead subsequently released results from the sponsored, randomized phase 3 SIMPLE trial, which found that a 5-day course of the drug improved outcomes among patients hospitalized with COVID-19 who did not need ventilation. The National Institutes of Health said that the most benefit was in patients on oxygen who did not require ventilation.

Remdesivir should be the "standard of care," according to Dr Anthony Fauci, though Dutch investigators have cautioned that it can be associated with rare but severe liver complications.

Bottom line on remdesivir. Remdesivir is administered intravenously, limiting its use to hospitalized patients. However, phase 1 trials of an inhaled nebulized version were initiated in late June 2020 to determine whether remdesivir can be used on an outpatient basis and at earlier stages of disease. The FDA has warned against use of remdesivir in combination with hydroxychloroquine (HCQ) . Stay current on remdesivir.

Dexamethasone

A cheap and widely available steroid roared to international attention in June with the announcement by British researchers that the RECOVERY trial involving over 6000 patients had been halted early due to positive results. The investigators reported that dexamethasone reduced death rates by about a third among severely ill hospitalized COVID-19 patients. Initial reaction in the United States was mixed.

While a number of clinicians indicated that the results confirmed their own experience, others were wary of embracing the study results prior to peer review. That may change, however, with the announcement by the Infectious Diseases Society of America (IDSA) that the drug will now be incorporated into COVID-19 treatment guidelines. Dexamethasone, or an equivalent steroid such as methylprednisolone or prednisone, is recommended for hospitalized patients who require supplemental oxygen, mechanical ventilation, or extracorporeal mechanical oxygenation.

Bottom line on dexamethasone. While corticosteroids are not generally recommended for treatment of COVID-19 or any viral pneumonia, the UK RECOVERY trial changed that. IDSA guidelines include low-dose dexamethasone (6 mg orally or intravenously daily for 10 days) in patients requiring respiratory support. At present, the World Health Organization has cautioned clinicians to reserve use for severely ill patients. Stay current on dexamethasone.

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