By Ryan Basen
Countless therapies have been tried for COVID-19. Not all have failed as spectacularly as hydroxychloroquine, so it can be difficult to keep track of what’s been proven to work, and what has not.
Below is a live list of currently authorized and/or validated therapies — noting the stage of disease for which they work best — as well as some others that didn’t pan out or are still under evaluation.
MedPage Today will continue to update this list as new information becomes available. Originally published March 17, 2021
Treatments in Use
Remdesivir (Veklury), an antiviral, is currently the only FDA-approved therapy for COVID-19. It was approved in October 2020 for hospitalized COVID-19 patients ages 12 and up who weigh at least 88 lbs. Its original emergency use authorization (EUA) has been revised to also allow for treatment of hospitalized pediatric patients under 12 who weigh at least 7.7 lbs.
FDA also issued an EUA for the combination of remdesivir plus the oral JAK inhibitor baricitinib (Olumiant) in hospitalized patients with severe COVID-19. (See baricitinib section below.)
NIH guidelines recommend the use of remdesivir in hospitalized patients who require supplemental oxygen, either on its own, or in combination with dexamethasone. For those requiring high-flow or noninvasive ventilation, NIH recommends remdesivir only in combination with dexamethasone.
The NIH originally recommended remdesivir for use in mechanically ventilated patients, but limited its scope of use in December 2020, due to a “lack of data showing benefit at this advanced stage of the disease.”
Dexamethasone, a corticosteroid with potent anti-inflammatory effects, is recommended for use in many categories of patients hospitalized with COVID-19, but not for those with mild-to-moderate disease who aren’t in the hospital.
While it recommends against dexamethasone for those hospitalized but not on supplemental oxygen, NIH recommends it for those who need supplemental oxygen, high-flow or noninvasive ventilation, and mechanical ventilation or extracorporeal membrane oxygenation (ECMO).
If dexamethasone isn’t available, an alternative corticosteroid such as prednisone, methylprednisolone, or hydrocortisone can be used, NIH says.
On June 24, the FDA authorized tocilizumab (Actemra) for the treatment of hospitalized adult and pediatric patients on systemic corticosteroids and supplemental oxygen, non-invasive or mechanical ventilation, or ECMO.
The NIH recommends using tocilizumab in combination with dexamethasone in certain hospitalized COVID patients exhibiting rapid respiratory decompensation. That includes those who have been admitted to the ICU within the previous 24 hours who require invasive mechanical ventilation, noninvasive mechanical ventilation or high-flow nasal cannula oxygen.
Tocilizumab (or baricitinib) can also be used in combination with dexamethasone alone or dexamethasone plus remdesivir in hospitalized patients on high-flow oxygen or noninvasive ventilation who have evidence of clinical progression or increased markers of inflammation.
NIH said there wasn’t enough evidence to identify which patients requiring supplemental oxygen therapy might benefit from adding tocilizumab (or baricitinib) to dexamethasone, with or without remdesivir. “Some Panel members would add either baricitinib or tocilizumab to patients who are exhibiting signs of systemic inflammation and rapidly increasing oxygen needs while on dexamethasone, but who do not yet require high-flow oxygen or noninvasive ventilation,” the guidance states.
The agency says tocilizumab should be avoided for “significantly” immunocompromised patients.
There’s no evidence for using other IL-6 inhibitors in COVID-19, but many remain under study.
On May 27, the NIH said physicians could use baricitinib (or tocilizumab) in combination with dexamethasone alone or dexamethasone plus remdesivir for treating hospitalized patients on high-flow oxygen or noninvasive ventilation who have evidence of clinical progression or increased markers of inflammation.