Abstract
The Emergency Department (ED), in the USA, is usually the first entry into the healthcare system. This chapter will help providers understand the therapeutic agents available for the management of COVID-19 infections. There is an abundance of literature being published and in a very quick manner, and we want to lay out the most evidence-based pharmacological agents available. Management of COVID-19 will depend on severity of the infection at presentation. Current evidence will support corticosteroids, thromboprophylaxis, and remdesivir. Limited evidence exists around the monoclonal antibodies, at this time. Some treatment options are to be initiated earlier and in higher-risk patient populations to reduce progression to more severe disease and hospitalization.
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Abbreviations
- APAP:
-
Acetaminophen
- ECMO:
-
Extracorporeal membrane oxygenation
- ED:
-
Emergency Department
- EUA:
-
Emergency use authorization
- FDA:
-
Federal Drug Administration
- mAbs:
-
Monoclonal antibodies
- MDI:
-
Metered dose inhaler
- NIH:
-
National Institutes of Health
- PPE:
-
Personal protective equipment
References
Sanders JM, Monogue ML, Jodlowski TZ, Cutrell JB. Pharmacologic treatments for coronavirus disease 2019 (COVID-19): a review. JAMA. 2020;323(18):1824–36. Available at: https://www.ncbi.nlm.nih.gov/pubmed/32282022. (Review of therapeutic agents).
National Institutes of Health. Coronavirus disease 2019 (COVID-19) treatment guidelines. Updated 2020 Oct 9. From NIH website https://www.covid19treatmentguidelines.nih.gov/). Accessed 2020 Nov 20. (Supportive care and remdesivir, duration).
Jeong HE, Lee H, Shin HJ et al. Association between NSAIDs use and adverse clinical outcomes among adults hospitalized with COVID-19 in South Korea: a nationwide study. Clin Infect Dis 2020. PMID: 32717066. https://doi.org/10.1093/cid/ciaa1056 (NSAIDs).
Rinott E, Kozer E, Shapira Y, et al. Ibuprofen use and clinical outcomes in COVID-19 patients. Clin Infect Dis 2020. PMID: 32535147. https://doi.org/10.1016/j.cmi.2020.06.003 (NSAIDs).
Ari A. Practical strategies for a safe and effective delivery of aerosolized medications to patients with COVID-19. Respir Med. 2020;167:105987. https://doi.org/10.1016/j.rmed.2020.105987. (Safety of new drugs).
Gilead Sciences. Veklury® (remdesivir) for injection and injection prescribing information. Foster City, CA; 2020 Oct. (Remdesivir).
Beigel JH, Tomashek KM, Dodd LE et al. Remdesivir for the treatment of Covid-19 - final report. N Engl J Med 2020; 383(19):1813. Epub 2020 Oct 8. PMID: 32445440. https://doi.org/10.1056/NEJMoa2007764 (Remdesivir).
Adamsick ML, Gandhi RG, Bidell MR et al. Remdesivir in patients with acute or chronic kidney disease and COVID-19. J Am Soc Nephrol 2020; 31(7):1384. Epub 2020 Jun 8. PMID: 32513665. https://doi.org/10.1681/ASN.2020050589 (remdesivir and kidney).
Spinner CD, Gottlieb RL, Criner GJ 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; 324:1048–1057. PMID: 32821939. https://doi.org/10.1001/jama.2020.16349. (remdesivir duration).
Goldman JD, Lye DCB, Hui DS, et al. Remdesivir for 5 or 10 days in patients with severe covid-19. N Engl J Med. 2020. PMID: 32459919. https://doi.org/10.1056/NEJMoa2015301 (remdesivir duration).
Pan H, Peto R, Karim QA et al. Repurposed antiviral drugs for COVID-19 – interim WHO SOLIDARITY trial results. medRxiv. Posted Oct 15, 2020. Preprint (not peer reviewed). (https://www.medrxiv.org/content/10.1101/2020.10.15.20209817v1). (WHO).
World Health Organization. Therapeutics and COVID-19: living guideline. https://www.who.int/publications/i/item/therapeutics-and-covid-19-living-guideline. Accessed 20 Nov 2020. PMID: 32887691 (WHO).
Fact sheet for healthcare providers: Emergency use authorization (EUA) of baricitinib. https://www.fda.gov/media/143823/download. Accessed 23 Nov 2020).
Study to evaluate the safety and efficacy of remdesivir (GS-5734) treatment of coronavirus disease 2019 (COVID-19) in an outpatient setting. NCT04501952. https://clinicaltrials.gov/ct2/show/NCT04501952. (outpatient).
Marovich M, Mascola JR, Cohen MS. Monoclonal antibodies for prevention and treatment of COVID-19. JAMA 2020; 324:131–132. PMID: 32539093. https://doi.org/10.1001/jama.2020.10245. (mAbs).
Zost SJ, Gilchuk P, Case JB et al. Potently neutralizing and protective human antibodies against SARS-CoV-2. Nature 2020; 584:443–449. PMID: 32668443. https://doi.org/10.1038/s41586-020-2548-6 (mAbs).
Chen et al. SARS-CoV-2 neutralizing antibody LY-CoV555 in outpatients with COVID-19. N Engl J Med. 2020 Oct 28 [epub ahead of print]. PMID: 33113295. https://doi.org/10.1056/NEJMoa2029849.
A Study of LY3819253 (LY-CoV555) and LY3832479 (LY-CoV016) in Participants Hospitalized with Mild to Moderate COVID-19 Illness (BLAZE-1). NCT04427501. Update posted 2020 Sep 18. https://www.clinicaltrials.gov/ct2/show/study/NCT04427501.
A Study of LY3819253 (LY-CoV555) in Participants Hospitalized for COVID-19. NCT04411628. Update posted 2020 Oct 30. https://www.clinicaltrials.gov/ct2/show/study/NCT04411628.
Desai A. What is herd immunity. JAMA. 2020;324(20):2118.
Rubin, Rita Difficult to determine herd immunity threshold for COVID-19 JAMA. 2020;3248;732.
Ada GL. The ideal vaccine. World J Microbiol Biotech. 1991;7(2):105–9.
Hassan et al., 2020, Cell 183, 169–184 October 1, 2020 a 2020 Elsevier Inc. https://doi.org/10.1016/j.cell.2020.08.026.
Graham BS, Corbett KS. Prototype pathogen approach for pandemic preparedness: world on fire. J Clin Invest. 2020. https://doi.org/10.1172/JCI139601.
Nature. 2020;579(7798):265–269. Published online 2020 Feb 3.
Hassett KJ, et al. Optimization of lipid nanoparticles for intramuscular administration of mRNA vaccines. Mol Ther Nucleic Acids. 2019;15:1–11. https://doi.org/10.1016/j.omtn.2019.01.013.
Nanotechnology for COVID-19: Therapeutics and Vaccine Research.
Graham B, Rapid S. COVID-19 vaccine development. Science. 2020;368:945–6. https://doi.org/10.1126/science.abb8923.
Walls AC, et al. Cryo-electron microscopy structure of a coronavirus spike glycoprotein trimer. Nature. 2016;531:114–7. https://doi.org/10.1038/nature16988.
Graham BS, Sullivan NJ. Emerging viral diseases from a vaccinology perspective: preparing for the next pandemic. Nat Immunol. 2018;19:20–8. https://doi.org/10.1038/s41590-017-0007-9.
SARS-CoV-2 mRNA Vaccine Development Enabled by Prototype Pathogen Preparedness.
Safety and Immunogenicity of Two RNA-Based Covid-19 Vaccine Candidates Edward Walsh NEJM 2020.
Krammer F. SARS-CoV-2 vaccines in development. Nature. 2020;586:516–27. https://doi.org/10.1038/s41586-020-2798-.
Kai Kupferschmidt Health coronavirus Science do110:1126.
Dong Y, Dai T, Wei Y, et al. A systematic review of SARS-CoV-2 vaccine candidates. Sig Transduct Target Ther. 2020;5:237. https://doi.org/10.1038/s41392-020-00352-y.
Amanai F, Krammer Floian SARS-CoV-2 Vaccines: Status.
Gregory Poland Mayo Clinic Proceedings SARS Vaccine Development: Current Status.
Abbasi J. COVID-19 and mRNA vaccines—first large test for a new approach. JAMA. 2020;324(12):1125–7. https://doi.org/10.1001/jama.2020.16866.
COVID-19 Vaccine Candidate. MGH Nov 2020. SARS-CoV-2 Vaccine.
Liu Y, Wang K, Massoud TF, Paulmurugan R. Development: an overview and perspectives. ACS Pharmaco Trans Sci. 2020;3(5):844–58. https://doi.org/10.1021/acsptsci.0c00109.
Johnson and Johnson study protocol for vaccine.
Safety and Efficacy of the BNT162b2 mRNA Covid-19 Vaccine NEJM 12/2020.
AstraZeneca/oxford covid-19 vaccine efficacy 12/2020.
CDC Government Mutant Variant of SAR-CoV-2 in UK and South Africa.
Mudgal R, et al. Prospects for mucosal vaccine: shutting the door on SARS-CoV-2. Human Vacc Immunother. 2020. https://doi.org/10.1080/21645515.2020.1805992.
Sara Reardon Scientific American Jan 29, 2021.
CDC.GOV Understanding mRNA COVID-19 Vaccines.
Campell R. Emergency department diagnosis and treatment of anaphylaxis: a practice parameter. Ann Allergy Asthma Immunol. 2014;1139:599–608.
Lee W. Yip: antibody-dependent enhancement and SARS-CoV-2 vaccines and therapeutics. Nat Microbiol. 2020;5:1185–91.
Tetro J. Is COVID-19 receiving ADE from other coronaviruses? Microbes Infection. 2020;22(2):72–3.
Zaichuk TA, Nechipurenko YD, Adzhubey AA, et al. The challenges of vaccine development against Betacoronaviruses: antibody dependent enhancement and Sendai virus as a possible vaccine vector. Mol Biol. 2020.
Al-Betar MA, Alyasseri ZAA, Awadallah MA, et al. Coronavirus herd immunity optimizer (CHIO). Neural Comput & Applic. 2020.
Faria NR, Claro IM. Genomic characterisation of an emergent SARS-CoV-2 lineage in Manaus: preliminary findings. https://doi.org/10.1007/s00521-020-05296-6.
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Johnson, D., Searcy, R., Whisenant, B. (2021). Pharmacological Agents for COVID-19 Patients. In: Shiber, J.R. (eds) Critical Care of COVID-19 in the Emergency Department. Springer, Cham. https://doi.org/10.1007/978-3-030-85636-6_15
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DOI: https://doi.org/10.1007/978-3-030-85636-6_15
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