At present, use of these therapies is based on a limited available evidence. As the situation evolves, and when more data become available, the evidence will be accordingly incorporated, and recommendation upgraded.
Currently, these drugs should only be used in a defined subgroup of patients:
- Remdesivir - Under Emergency Use Authorization may be considered in patients with moderate disease (those on oxygen) with none of the following contraindications: AST/ALT > 5 times Upper limit of normal (ULN), Severe renal impairment (i.e., eGFR < 30ml/min/m2 or need for hemodialysis), Pregnancy or lactating females, Children (< 12 years of age)
- Convalescent plasma - may be considered in patients with moderate disease who are not improving (oxygen requirement is progressively increasing) despite use of steroids.
- Tocilizumab - It may be considered in patients with moderate disease with progressively increasing oxygen requirements and in mechanically ventilated patients not improving despite use of steroids. Long term safety data in COVID 19 remains largely unknown.
. Repurposed or off-label therapies
- Hydroxychloroquine - This drug has demonstrated in vitro activity against SARS-CoV2 and was shown to be clinically beneficial in several small single center studies though with significant limitations.
Nonetheless, several large observational studies with severe methodologic limitations have shown no effect on mortality or other clinically meaningful outcomes.
As such, the evidence base behind its use remains limited as with other drugs and should only be used after shared decision making with the patients while awaiting the results of ongoing studies.
As is the case with other antivirals, this drug should be used as early in the disease course as possible to achieve any meaningful effects and should be avoided in patients with severe disease.
An ECG should ideally be done before prescribing the drug.