J Pharm Pharm Sci (www.cspsCanada.

org) 23, 58 - 64, 2020

Current Drugs with Potential for Treatment of COVID-19: A Literature

Review
Md Insiat Islam Rabby

Department of Mechanical and Manufacturing Engineering, Universiti Putra Malaysia, Malaysia

Received, March 26, 2020; Revised, April 2, 2020; Accepted, April 3, 2020; Published, April 4, 2020.

ABSTRACT - Purpose: SARS-CoV-2 first emerged in China in December 2019 and rapidly spread worldwide.
No vaccine or approved drug is available to eradicate the virus, however, some drugs that are indicated for other
afflictions seems to be potentially beneficial to treat the infection albeit without unequivocal evidence. The aim
of this article is to review the published background on the effectiveness of these drugs against COVID-19
Methods: A thorough literature search was conducted on recently published studies which have published
between January 1 to March 25, 2020. PubMed, Google Scholar and Science Direct databases were searched
Results: A total 22 articles were found eligible. 8 discuss about treatment outcomes from their applied drugs
during treatment of COVID-19 patients, 4 report laboratory tests, one report animal trial and other 9 articles
discuss recommendations and suggestions based on the treatment process and clinical outcomes of other diseases
such as malaria, ebola, severe acute respiratory syndrome (SARS) and Middle East respiratory syndrome (MERS).
The data and/or recommendations are categorized in 4 classes: (a) anti-viral and anti-inflammatory drugs, (b)
anti-malaria drugs, (c) traditional Chinese drugs and (d) other treatments/drugs. Conclusion: All examined
treatments, although potentiality effective against COVID-19, need either appropriate drug development or
clinical trial to be suitable for clinical use.
__________________________________________________________________________________________

INTRODUCTION

The world has experienced various dangerous clinical trials albeit, a list of ongoing registered
outbreaks of various intensities such as ebola, clinical trials have been reported by Zhang et al (7).
cholera, Spanish flu, American seasonal flu. Now Herein, a thorough literature review on these
we are facing an arguably a more dangerous viral treatments are presented.
endemic with COVID-19. This severe acute
respiratory syndrome coronavirus 2 (SARS-CoV-2), METHODS
formerly known as the 2019 novel Coronavirus
(2019nCoV or COVID-19), is a single-stranded Search and selection strategy
RNA beta-coronavirus whose genome encodes are A literature search was conducted to cover the period
structural proteins, non-structural proteins and January 1-March 25, 2020. PubMed, Google Scholar
accessory proteins (1). It has globally already and Science Direct databases were selected as search
infected 413467 people and killed 18,433 people by strings. EndNote X 9.0 software was used to exclude
25 March, 2020 (2) and the casualties are growing duplicates from searched data. “Treatment for
exponentially. In the meantime, only 113453 COVID-19” AND “Vaccine, Anti-viral drugs, Anti-
patients have recovered which is 27.45% of total malaria drugs, Traditional Chinese Medicine for
affected population (2). The characteristics of the COVID-19” such keywords were using in search
infected population is already published (3, 4). string without considering any restriction of
Various treatments have been suggested and applied language to identify potential published studies.
to control COVIDE-19 based on previous Moreover, missing studies were identified by
experiences with other viral infections such as checking the reference list of the selected articles.
malaria, ebola and cholera (6). In addition, a ___________________________________________________
systematic review of the effect of chloroquine on
Corresponding Author: Md Insiat Islam Rabby; Department of
COVID-19 infection has appeared (5). However, Mechanical and Manufacturing Engineering, Universiti Putra
these treatments have resulted in controversy as are Malaysia, Malaysia; insiatislam8@gmail.com.
not based on data generated from direct conventional

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The studies which describe about the current recorded. For the case studies and laboratory tests,
treatment process and drugs for COVID-19 infection when the drugs applied, the size of the dose, sex and
were selected to conduct this study wherein some age of patients were noted.
editorial and letter to editor were also included which
mainly recommended some drugs based on the RESULTS
treatment process of previous epidemic viruses such
as malaria, ebola, severe acute respiratory syndrome A total of 1153 articles initially identified. After
(SARS) and middle east respiratory syndrome removing duplicates, checking title, abstract and full
(MERS). Meanwhile, studies which (a) duplicate text 22 were found eligible based on the
publications (b) full articles not available (c) predetermined exclusion and inclusion criteria for
literature reviews and (d) do not provided sufficient this study. From this 22 articles, 8 were case reports
information or support regarding their which reported treatment of COVID-19 patients, 4
recommendation of their proposed drugs or reported laboratory tests, one reported animal trial
treatment process were excluded. However, few and others 9 reported recommendations and
articles which are still in press also selected for this suggestions based on experience involving the use
analysis to meet the aim of this study. The steps of drugs in other viral infection; i.e., malaria, ebola,
taken to conduct the present search are presented in severe acute respiratory syndrome (SARS) and
Figure 1. middle east respiratory syndrome (MERS). These
studies are summarized in Table 1. Based on the
Data extraction and analysis information and authors comments, the drugs are
To conduct this study the author, date, name and categorized in 4 classes- (a) Anti-viral and Anti-
category of the drugs, effectiveness of the drugs, inflammable drugs, (b) Anti-malaria drugs, (c)
reason for effectiveness, the type of observation Traditional Chinese drugs (TCM) and (d) other
(hospital/ clinical trial/ animal trial/ laboratory) were treatments/drugs.
Identification

Form Google Scholar, From Science Direct, From Web of Science,

From PubMed, n=353
n=355 n=243 n=202

After removing duplicates articles, n=52

Screening

selection)
(Primary

Records screened, n= Records excluded

52 (n=17)
Eligibility

Eligibility for full text, n= 35 Full text excluded, n=13

Included

Included, for analysis, n= 22

Figure 1. Summary of study selection design

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Table 1. Summary of findings reported in selected articles

Study Drugs applied or Type of report Outcomes drugs Category
suggested

Wen et al Glucocorticoids, IL-6 Clinical observation Improved clinical outcome Anti-malarial and anti-
(8) antagonist, JAK inflammatory
inhibitors and
chloroquine/
hydroxychloroquine

Gautret et Azithromycin plus Open label non- An Improved efficacy to Anti-viral plus anti-
al (9) hydroxychloroquine. randomized clinical trial eradicate the virus inflammatory
for 6 days with 6 COVID-19 positive
patients

Runfeng et Lianhuaqingwen Laboratory test using Protection against COVID-19 Traditional Chinese
al (10) African green monkey virus attract Medicine
kidney epithelial (Vero
E6) cells and the human
hepatocellular carcinoma
(Huh-7) cells

Liu et al Hydroxychloroquine in vitro cytotoxicity and HCQ a safe and effective Anti-malarial, anti-
(11) and chloroquine antiviral tests treatment against COVID-19 inflammatory

Zahra et al Hydroxychloroquine Opinion paper Hydroxychloroquine is preferred Anti-malarial, Anti-viral and

(12) chloroquine and to over chloroquine as they are others
several other equally effective as antimalarial
therapeutic agents drug but the former has a more
favorable safety profile

Cai et al Favipiravir (n=35) vs Open label clinical trial Significantly shorter COVID-19 Anti-viral
(13) control (lopinavir or clearance and improved chest
ritonavir n=45). All imaging with favipiravir as
received interferon compared with control
alfa
Wu et al Janus kinase 2 in vitro murine TH17 cell Fedratinib suppresses Anti-inflammatory
(14) (JAK2) study expression of IL17, IL 22 and
Inhibitor fedratinib L23 with no effect on IL 22.
Thus the drug may be beneficial
in reducing cytokine storm
associated with COVID-19
infection

Yao et al Chloroquine and in vitro infected vero Substantial lower EC50 for Anti-malarial
(15) hydroxychloroquine cells hydroxychloroquine vs
chloroquine in inhibiting
COVId-19

Tang et al Lopinavir plus Case study; COVID-19- Improved clinical symptoms. Antiviral
(16) ritonavir induced pneumonia on a Inconclusive whether the
hemodialysis patient antiviral therapy was effective.

Fan et al Cepharanthine, Cell culture and pangolin Complete inhibition of Anti-inflammatory/

(17) selamectin and coronavirus modelling cytopathic effects in cell culture antineoplastic, anti-parasitic,
mefloquine by all three drugs.

Ren et al Qingfei paidu A single case study Controlling of COVID-19 Traditional Chinese
(18) decoction, symptoms. . Medicine

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Table 1. Continued…

Stebbing et Baricitinib, in silico artificial Prediction of significant JAK inhibitors Anti-

al (19) fedratinib, and intelligence prediction beneficial effects in the inflammatory agents
ruxolitinib treatment of COVID-19

Gordon et Remdesivir in vitro co-expression of The proteins form a complex Broad spectrum RNA
al (20) MERS-CoV nonstructural and likely delay RNA chain polymerase inhibitor anti-
proteins in insect cells termination. Also nucleotides viral
may protect the inhibitor from
excision. These may explain the
high potency of remdesivir
against RNA viruses in cell-
based assays.

Nguyen et CRISPR/Cas13d in vitro tests They proposed that Others treatment/drugs

al (21) strategy for treating CRISPR/Cas13d system has
2019-nCov(SARS- straightforward and flexible
CoV-2) virus potentiality for RNA virus
infection treatment and prevention which
may be used for the treatment of
COVID-19

Guangdi & Remdesivir, Opinion The authors claimed that these Anti-viral
De Clercq umifenovir, inhibitors have appropriate
(1) oseltamivir and potential biocontainment
ASC09F, around 50 capability against covid-19.
existing MERS
and/or SARS
inhibitors, such as the
protease inhibitors
GC813, galidesivir,
compound 3k, the
nucleoside analogue
pyrazofurin and the
helicase inhibitor
SSYA10-001

Sun Meli et Renin-Angiotensin opinion Authors opine that RAS Others treatment/drugs
al (22) System (RAS) inhibitors have the ability to
inhibitors alleviate several symptoms of
acute severe pneumonia and also
relieve respiratory failure ACEI
and AT1R inhibition

Lim et al Lopinavir/ritonavirA Single patient clinical case Lopinavir/ritonavir significantly Anti-viral

(23) reduced COVID-19 load

Kruse (24) Angiotensin- Opinion ACE2-Fc has the potentiality to Others treatment/drugs
converting enzyme 2, be the neutralizing antibody that
fused to an can be used for the treatment of
immunoglobulin Fc COVID-19
domain.

Wang M. Remdesivir, ribavirin, In vitro test using COVIC- All tested drugs were effective Anti-viral and Anti-malarial
et al (25) penciclovir, 19 infected Vero E6 cells with Remdesivir and,
nitazoxanide, chloroquine having most potent
nafamostat, activities.
remdesivir favipiravir
and chloroquine

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Table 1. Continued…

Wang, Z. et Lopinavir/ritonavir, Case report of 4 patients The treatments were effective. Anti-viral and Anti-malarial
al (26) arbidol, and Shufeng
Jiedu (Chinese med)

Holshue et Remdesivir Single patient case report Patient recovered. Anti-viral

al (27)

H.L. Zhang Traditional Chinese A single patient case Patient recovered. Traditional Chinese
and Y.X. Medicine report Medicine
Zhu (28)

DISCUSSION and CONCLUSION environmental effects, studies involving patients

from other geographical regions are needed.
This literature review and analysis was conducted Additionally, detailed information of patients,
based on recently published studies on treatment of clinical and laboratory outcomes of recommended
COVID-19 diseases. drugs were unavailable for most of the cases
This review clearly demonstrates that the included in this review.
available data are not sufficient to suggest any
treatment for eradication of COVID-19 to be used at CONFLICTS OF INTEREST
the clinical level. All human studies lack
comparative data so that it remains unclear whether No conflicts of interest.
the patient recovered because of the use of particular
drug or the general clinical care received. Most in FUNDING SOURCE
vitro studies, however, are suggestive of potential
beneficial effects although the data are too Author did not receive any fund for this study.
preliminary to be used as rationale for clinical use.
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