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Pharmacological Treatment of Patients with Mild to Moderate COVID-19: A Comprehensive Review

Mild to moderate COVID-19 can be found in about 80% of patients. Although mortality is low, mild to moderate COVID-19 may progress to severe or even critical stages in about one week. This poses a substantial burden on the health care system, and ultimately culminates in death or incapacitation and...

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Autores principales: Bestetti, Reinaldo B., Furlan-Daniel, Rosemary, Silva, Vinicius M. R.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: MDPI 2021
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8297311/
https://www.ncbi.nlm.nih.gov/pubmed/34281149
http://dx.doi.org/10.3390/ijerph18137212
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author Bestetti, Reinaldo B.
Furlan-Daniel, Rosemary
Silva, Vinicius M. R.
author_facet Bestetti, Reinaldo B.
Furlan-Daniel, Rosemary
Silva, Vinicius M. R.
author_sort Bestetti, Reinaldo B.
collection PubMed
description Mild to moderate COVID-19 can be found in about 80% of patients. Although mortality is low, mild to moderate COVID-19 may progress to severe or even critical stages in about one week. This poses a substantial burden on the health care system, and ultimately culminates in death or incapacitation and hospitalization. Therefore, pharmacological treatment is paramount for patients with this condition, especially those with recognized risk factors to disease progression. We conducted a comprehensive review in the medical literature searching for randomized studies carried out in patients with mild to moderate COVID-19. A total of 14 randomized studies were identified, enrolling a total of 6848 patients. Nine studies (64%) were randomized, placebo-controlled trials, whereas five were open-label randomized trials (35%). We observed that Bamlanivimab and nitazoxanide reduced viral load, whereas ivermectin may have shortened time to viral clearance; Interferon Beta-1 reduced time to viral clearance and vitamin D reduced viral load; Favirapir, peginterferon, and levamisole improved clinical symptoms, whereas fluvoxamine halted disease progression; inhaled budesonide reduced the number of hospitalizations and visits to emergency departments; colchicine reduced the number of deaths and hospitalizations. Collectively, therefore, these findings show that treatment of early COVID-19 may be associated with reduced viral load, thus potentially decreasing disease spread in the community. Moreover, treatment of patients with mild to moderate COVID-19 may also be associated with improved clinical symptoms, hospitalization, and disease progression. We suggest that colchicine, inhaled budesonide, and nitazoxanide, along with nonpharmacological measures, based on efficacy and costs, may be used to mitigate the effects of the COVID-19 pandemic in middle-income countries.
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spelling pubmed-82973112021-07-23 Pharmacological Treatment of Patients with Mild to Moderate COVID-19: A Comprehensive Review Bestetti, Reinaldo B. Furlan-Daniel, Rosemary Silva, Vinicius M. R. Int J Environ Res Public Health Review Mild to moderate COVID-19 can be found in about 80% of patients. Although mortality is low, mild to moderate COVID-19 may progress to severe or even critical stages in about one week. This poses a substantial burden on the health care system, and ultimately culminates in death or incapacitation and hospitalization. Therefore, pharmacological treatment is paramount for patients with this condition, especially those with recognized risk factors to disease progression. We conducted a comprehensive review in the medical literature searching for randomized studies carried out in patients with mild to moderate COVID-19. A total of 14 randomized studies were identified, enrolling a total of 6848 patients. Nine studies (64%) were randomized, placebo-controlled trials, whereas five were open-label randomized trials (35%). We observed that Bamlanivimab and nitazoxanide reduced viral load, whereas ivermectin may have shortened time to viral clearance; Interferon Beta-1 reduced time to viral clearance and vitamin D reduced viral load; Favirapir, peginterferon, and levamisole improved clinical symptoms, whereas fluvoxamine halted disease progression; inhaled budesonide reduced the number of hospitalizations and visits to emergency departments; colchicine reduced the number of deaths and hospitalizations. Collectively, therefore, these findings show that treatment of early COVID-19 may be associated with reduced viral load, thus potentially decreasing disease spread in the community. Moreover, treatment of patients with mild to moderate COVID-19 may also be associated with improved clinical symptoms, hospitalization, and disease progression. We suggest that colchicine, inhaled budesonide, and nitazoxanide, along with nonpharmacological measures, based on efficacy and costs, may be used to mitigate the effects of the COVID-19 pandemic in middle-income countries. MDPI 2021-07-05 /pmc/articles/PMC8297311/ /pubmed/34281149 http://dx.doi.org/10.3390/ijerph18137212 Text en © 2021 by the authors. https://creativecommons.org/licenses/by/4.0/Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/).
spellingShingle Review
Bestetti, Reinaldo B.
Furlan-Daniel, Rosemary
Silva, Vinicius M. R.
Pharmacological Treatment of Patients with Mild to Moderate COVID-19: A Comprehensive Review
title Pharmacological Treatment of Patients with Mild to Moderate COVID-19: A Comprehensive Review
title_full Pharmacological Treatment of Patients with Mild to Moderate COVID-19: A Comprehensive Review
title_fullStr Pharmacological Treatment of Patients with Mild to Moderate COVID-19: A Comprehensive Review
title_full_unstemmed Pharmacological Treatment of Patients with Mild to Moderate COVID-19: A Comprehensive Review
title_short Pharmacological Treatment of Patients with Mild to Moderate COVID-19: A Comprehensive Review
title_sort pharmacological treatment of patients with mild to moderate covid-19: a comprehensive review
topic Review
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8297311/
https://www.ncbi.nlm.nih.gov/pubmed/34281149
http://dx.doi.org/10.3390/ijerph18137212
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