Which of the statements on COVID-19 therapies are correct? A Test.

Last update and review: April 14, 2020.

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A group of authors from Italy published an article on treatment of COVID-19.

Given Italy’s catastrophic COVID-19 mortality rates, it is informative to take a look at the treatment option used by the Italian medical doctors.

A Test:

In the citation below, which of the statements on COVID-19 therapies are correct and which are questionable or incorrect?

Other therapies

Among other therapeutic strategies, systemic corticosteroids for the treatment of viral pneumonia or acute respiratory distress syndrome (ARDS) are not recommended. Moreover, unselective or inappropriate administration of antibiotics should be avoided, although some centers recommend it. Although no antiviral treatments have been approved, several approaches have been proposed such as lopinavir/ritonavir (400/100 mg every 12 hours), chloroquine (500 mg every 12 hours), and hydroxychloroquine (200 mg every 12 hours). Alpha-interferon (e.g., 5 million units by aerosol inhalation twice per day) is also used.

Preclinical studies suggested that remdesivir (GS5734) — an inhibitor of RNA polymerase with in vitro activity against multiple RNA viruses, including Ebola — could be effective for both prophylaxis and therapy of HCoVs infections.[18] This drug was positively tested in a rhesus macaque model of MERS-CoV infection.[19] 

In Italy, a great investigation led by the Istituto Nazionale Tumori, Fondazione Pascale di Napoli is focused on the use of tolicizumab. It is a humanized IgG1 monoclonal antibody, directed against the IL-6 receptor and commonly used in the treatment of rheumatoid arthritis.

When the disease results in complex clinical pictures of MOD, organ function support in addition to respiratory support, is mandatory. Extracorporeal membrane oxygenation (ECMO) for patients with refractory hypoxemia despite lung-protective ventilation should merit consideration after a case-by-case analysis. It can be suggested for those with poor results to prone position ventilation.

About the authors of the publication (1):

Authors

Marco Cascella¹; Michael Rajnik²; Arturo Cuomo³; Scott C. Dulebohn; Raffaela Di Napoli⁴.

Affiliations

¹ Istituto Nazionale Tumori – IRCCS – Fondazione Pascale, Via Mariano Semmola 80100, Napoli. Italy² Uniformed Services Un of the Health Sc³ Istituto Nazionale Tumori – IRCCS – Fondazione Pascale. Napoli, Italy⁴ Institut Jules Bordet

Last Update: March 20, 2020.

Selected references:

1. Cascella M, Rajnik M, Cuomo A, et al. Features, Evaluation and Treatment Coronavirus (COVID-19) [Updated 2020 Mar 20]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2020 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK554776/