Indian Journal of Respiratory Care

IJRC Email      Register      Login

VOLUME 10 , ISSUE S1 ( April, 2021 ) > List of Articles


Pharmacologic Treatment of COVID-19: Evidence-Based Update

Jose Chacko, Muhammed Unais

Keywords : Antiviral agents, COVID-19 pandemic, interleukin inhibitors, pharmacotherapy, steroids

Citation Information :

DOI: 10.4103/ijrc.ijrc_40_21

License: CC BY-NC-SA 4.0

Published Online: 06-12-2022

Copyright Statement:  Copyright © 2021; Indian Journal of Respiratory Care.


The COVID-19 pandemic continues to pose challenges on an unprecedented scale to health-care systems across the world. Mortality from COVID-19 remains low, and survival has improved compared to the early stages of the pandemic. Several new and repurposed therapeutic modalities continue to emerge as a part of our armamentarium to combat the damage triggered by the Severe Acute Respiratory Syndrome Coronavirus-2 virus. It is unclear if the more favorable clinical outcomes are attributable to specific pharmacological agents or improved care overall, as health-care systems attain increasing experience with a complex disease process. This review aims to provide an updated review of various pharmacological therapies that have been evaluated in the treatment of COVID-19 infection.

  1. Mulangu S, Dodd LE, Davey RT Jr., Tshiani Mbaya O, Proschan M, Mukadi D, et al. A randomized, controlled trial of ebola virus disease therapeutics. N Engl J Med 2019;381:2293-303.
  2. Holshue ML, DeBolt C, Lindquist S, Lofy KH, Wiesman J, Bruce H, et al. First case of 2019 novel coronavirus in the United States. N Engl J Med 2020;382:929-36.
  3. NIH Clinical Trial of Remdesivir to Treat COVID-19 Begins. National Institutes of Health (NIH); Published February 25, 2020. Available from: -remdesivir-treat-covid-19-begins. [Last accessed on 2020 Sep 13].
  4. Beigel JH, Tomashek KM, Dodd LE, Mehta AK, Zingman BS, Kalil AC, et al. Remdesivir for the treatment of Covid-19 - Preliminary report. N Engl J Med 2020; 383:1813-26. [doi: 10.1056/NEJMoa2007764].
  5. Spinner CD, Gottlieb RL, Criner GJ, Lopez JRA, Cattelan AM, Viladomiu AS, et al. Effect of Remdesivir vs Standard Care on Clinical Status at 11 Days in Patients With Moderate COVID-19: A Randomized Clinical Trial. JAMA. 2020;324:1048-57.
  6. WHO Solidarity Trial Consortium, Pan H, Peto R, Henao-Restrepo AM, Preziosi MP, Sathiyamoorthy V, et al. Repurposed antiviral drugs for Covid-19-Interim WHO solidarity trial results. N Engl J Med 2021;384:497-511.
  7. Kalil AC, Patterson TF, Mehta AK, Tomashek KM, Wolfe CR, Ghazaryan V, et al. Baricitinib plus remdesivir for hospitalized adults with Covid-19. N Engl J Med 2021;384:795-807.
  8. Ivashchenko AA, Dmitriev KA, Vostokova NV, Azarova VN, Blinow AA, Egorova AN, et al. AVIFAVIR for Treatment of Patients with Moderate COVID-19: Interim Results of a Phase II/III Multicenter Randomized Clinical Trial. Clin Infect Dis. 2020 Aug 9:ciaa1176. doi: 10.1093/cid/ciaa1176. Epub ahead of print. PMID: 32770240; PMCID: PMC7454388.
  9. Control of COVID-19 Outbreaks in Long Term Care-Full Text Available from: [Last accessed on 2020 Sep 13].
  10. Caly L, Druce JD, Catton MG, Jans DA, Wagstaff KM. The FDA-approved drug ivermectin inhibits the replication of SARS-CoV-2 in vitro. Antiviral Res 2020;178:104787.
  11. Momekov G, Momekova D. Ivermectin as a potential COVID-19 treatment from the pharmacokinetic point of view: Antiviral levels are not likely attainable with known dosing regimens. Biotechnol Biotechnol Equip 2020;34:469-74. [doi: 10.1080/13102818.2020.1775118].
  12. López-Medina E, López P, Hurtado IC, Davalos DM, Ramirez O, Martinez E, et al. Effect of Ivermectin on Time to Resolution of Symptoms Among Adults With Mild COVID-19: A Randomized Clinical Trial. JAMA. 2021;325:1426-35.
  13. Yao X, Ye F, Zhang M, Cui C, Huang B, Niu P, et al. In vitro antiviral activity and projection of optimized dosing design of hydroxychloroquine for the treatment of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Clin Infect Dis 2020;71:732-9.
  14. No Clinical Benefit from Use of Hydroxychloroquine in Hospitalised Patients with COVID-19 - RECOVERY Trial. Available from: -the-randomised-evaluation-of-covid-19-therapy-recovery-trial-on-hyd roxychloroquine-5-june-2020-no-clinical-benefit-from-use-of-hydroxy chloroquine-in-hospitalised-patients-with-covid-19. [Last accessed on 2020 Sep 13].
  15. Tang W, Cao Z, Han M, Wang Z, Chen J, Sun W, et al. Hydroxychloroquine in patients with mainly mild to moderate coronavirus disease 2019: Open label, randomised controlled trial. BMJ 2020;369:m1849. [doi: 10.1136/bmj.m1849].
  16. Chacko J, Brar G, Premkumar R. Hydroxychloroquine in COVID-19: An updated systematic review with meta-analysis. medRxiv 2020.05.14.20101774; doi:
  17. Kashour Z, Riaz M, Garbati MA, AlDosary O, Tlayjeh H, Gerberi D, et al. Efficacy of chloroquine or hydroxychloroquine in COVID-19 patients: A systematic review and meta-analysis. J Antimicrob Chemother 2021;76:30-42.
  18. Roche Provides an Update on the Phase III COVACTA Trial of Actemra/RoActemra in Hospitalised Patients with Severe COVID-19 Associated Pneumonia. Available from: [Last accessed on 2020 Sep 14].
  19. REMAP-CAP Investigators, Gordon AC, Mouncey PR, Al-Beidh F, Rowan KM, Nichol AD, et al. Interleukin-6 receptor antagonists in critically ill patients with Covid-19. N Engl J Med 2021. DOI: 10.1056/NEJMoa2100433.
  20. Horby PW, Pessoa-Amorim G, Peto L, Brightling CE, Sarkar R, Thomas, et al. RECOVERY Collaborative Group. Tocilizumab in patients admitted to hospital with COVID-19 (RECOVERY): preliminary results of a randomised, controlled, open-label, platform trial. medRxiv 2021.02.11.21249258; doi:
  21. Cavalli G, De Luca G, Campochiaro C, Della-Torre E, Ripa M, Canetti D, et al. Interleukin-1 blockade with high-dose anakinra in patients with COVID-19, acute respiratory distress syndrome, and hyperinflammation: A retrospective cohort study. Lancet Rheumatol 2020;2:e325-31.
  22. Huet T, Beaussier H, Voisin O, Jouveshomme S, Dauriat G, Lazareth I, et al. Anakinra for severe forms of COVID-19: A cohort study. Lancet Rheumatol 2020;2:e393-400.
  23. Randomised Evaluation of COVID-19 Therapy-Full Text Available from: [Last accessed on 2020 Sep 13].
  24. Horby P, Lim WS, Emberson JR, Mafham M, Bell JL, Linsell L, et al. RECOVERY Collaborative Group. Dexamethasone in Hospitalized Patients with Covid-19. N Engl J Med. 2021;384:693-704. doi: 10.1056/NEJMoa2021436. Epub 2020 Jul 17. PMID: 32678530; PMCID: PMC7383595.
  25. Dequin P, Heming N, Meziani F, Plantefeve G, Voiriot G, Badie J, et al. Effect of Hydrocortisone on 21-Day Mortality or Respiratory Support Among Critically Ill Patients With COVID-19: A Randomized Clinical Trial. JAMA. 2020;324:1298-306.
  26. Li L, Zhang W, Hu Y, Tong X, Zheng S, Yang J, et al. Effect of convalescent plasma therapy on time to clinical improvement in patients with severe and life-threatening COVID-19: A randomized clinical trial. JAMA 2020;324:460-70.
  27. Effect of Convalescent Plasma on Mortality among Hospitalized Patients with COVID-19: Initial Three-Month Experience Joyner MJ, Senefeld JW, Klassen SA, Mills JR, Johnson PW, Theel ES, et al. the US EAP COVID-19 Plasma Consortium. medRxiv 2020.08.12.20169359. doi:
  28. Agarwal A, Mukherjee A, Kumar G, Chatterjee P, Bhatnagar T, Malhotra P, et al. Convalescent plasma in the management of moderate covid-19 in adults in India: open label phase II multicentre randomised controlled trial (PLACID Trial) BMJ 2020;371:m3939 doi:10.1136/bmj.m3939.
  29. Simonovich VA, Burgos Pratx LD, Scibona P, Beruto MV, Vallone MG, Vázquez C, et al. A randomized trial of convalescent plasma in Covid-19 severe pneumonia. N Engl J Med 2021;384:619-29.
PDF Share
PDF Share

© Jaypee Brothers Medical Publishers (P) LTD.