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Updated: November 10, 2020

What is the current evidence regarding emerging treatments for COVID-19?

Summary

The following is a summary of evidence sources that provide high quality information on emerging treatments for people with COVID-19. For additional information about each of the sources, see the Table below.   For additional information about each of the sources, see the Table below.

Currently, there is no cure for COVID-19 infections [7], although there are several emerging treatments to manage the symptoms and consequences of the disease. The Harvard Medical School states in its Treatment for COVID-19 guidance that most people who become infected with COVID-19 will recover with adequate rest, hydration, and management of symptoms such as fever and aches with over-the-counter drugs such as acetaminophen [7]. Many pharmacological treatments are being explored through COVID-19 clinical trials, including: 1) convalescent plasma as an antibody therapy; 2) corticosteroids as an anti-inflammatory to reduce hyper immune responses (i.e. dexamethasone, prednisone, etc.);3) remdesivir and hydroxychloroquine as antivirals; and 4) the anti-bacterial medication azithromycin to reduce the immune response [7]. ]. Currently, only corticosteroids (i.e. dexamethasone, prednisone and methylprednisolone) have been proven effective against severe and critical COVID-19.[2]  
 
In its “Solidarity” clinical trial for COVID-19 treatments report, the World Health Organization states that all four treatments that were evaluated by their Solidarity Trial (i.e., remdesivir, hydroxychloroquine, lopinavir/ritonavir and interferon) had little or no effect overall on mortality, initiation of ventilation and duration of hospital stay in hospitalized patients [2. The Centre for Evidence-Based Medicine reports in its More about chloroquine and hydroxychloroquine report that it is likely that even if chloroquine and hydroxychloroquine are effective in COVID-19, the beneficial effects will be small [1]. The risks of adverse reactions to these drugs are increased in patients who are sick with severe COVID-19 [1]. Overall, using hydroxychloroquine, interferon B-1a and lopinavir-ritonavir as a treatment for COVID-19 are not recommended by the National COVID-19 Clinical Evidence Taskforce [4]
 
In an evidence review by the Canadian Agency for Drugs and Technologies in Health (CADTH) on Remdesivir, it is reported that Health Canada has approved the use of remdesivir in Canada with specific conditions [3]. CADTH states that a shorter course of remdesivir may offer benefits in patients with moderate or severe COVID-19, while a five-to-ten-day course of remdesivir may reduce time to recovery in patients with severe COVID-19 [3]. Furthermore, the Australian National COVID-19 Clinical Evidence Taskforce suggests considering using remdesivir for adults hospitalised with COVID-19 who require oxygen but not ventilation [4]. Current guidelines by the National Institute of Health (NIH) in the United States for the treatment of COVID-19 is to use remdesivir and/or dexamethasone depending on the hospitalization and oxygen requirements [5]
 
The British Columbia Centre for Disease Control reports in its Treatments guidance that Tamiflu is used to treat and prevent Influenza A and B, and there is no evidence suggesting that it is effective against COVID-19 [8]. However, there are several clinical trials underway to explore the efficacy of Tamiflu as an adjuvant therapy in combination with other potential COVID-19 treatment therapies [9,10,11]
 
The Government of Canada regularly updates their list of COVID-19 drugs whose clinical trials are currently under investigation by Health Canada and can viewed here [6]

Evidence

What‘s Trending on Social Media and Media

The results of a global study, reviewed by the World Health Organization (WHO), on four treatment trials where remdesivir and three other repurposed drugs had conclusive evidence that the treatments do not have an impact on COVID-19? mortality, need for ventilation, and duration of hospital stays. The WHO state that they will continue to evaluate trials in new antiviral drugs, immunomodulators, and anti-SARS-CoV-2 antibodies. Access the CTV News article here. 
 
Although there are no treatments, on October 8, 2020 CBC News suggested experimental antibody drugs are promising therapies being tested for treating and preventing COVID-19 infections. The CBC News provide answers to questions about how treatments work, if treatments differ, when treatments may be available, and evidence behind the treatments. 

Organizational Scan

The City of Toronto and the Government of Canada state that there are no specific treatments for coronaviruses, but people who are hospitalized with COVID-19 and need breathing assistance may be treated with dexamethasone [12,13]
   
National Institutes of Health has launched an adaptive Phase 3 clinical trial to evaluate the safety and efficacy of three immune modulators drugs in hospitalized adults with COVID-19. The clinical trial aims to determine if regulating the immune response reduces the need for ventilators and can shorten hospital stays [14]
  
The Faculty of Medicine at the University of British Columbia announced a new clinical trial, led by Dr. Josef Penninger, that may uncover a treatment method for COVID-19. Dr. Penninger states that COVID-19 comes in varying stages, so different treatments and principles for different COVID-19 disease stages are needed [15]

Review of Evidence

Resource Type/Source of Evidence Last Updated
More about chloroquine and hydroxychloroquine
— CEBM: The Centre for Evidence-Based Medicine
Evidence Syntheses

This guidance notes that it is likely that even if chloroquine and hydroxychloroquine are effective in COVID-19, the beneficial effects will be small. The risks of adverse reactions to these drugs are increased in patients who are sick with severe COVID-19.  

Last Updated: August 29, 2020
“Solidarity” clinical trial for COVID-19 treatments
— WHO: World Health Organization
International Guidance

The WHO reports that all four treatments evaluated (remdesivir, hydroxychloroquine, lopinavir/ritonavir and interferon) had little or no effect overall on mortality, initiation of ventilation and duration of hospital stay in hospitalized patients. Currently, only corticosteroids have been proven effective against severe and critical COVID-19.  

Last Updated: October 14, 2020
Remdesivir
— CADTH: Canadian Agency for Drugs and Technologies in Health
National Guidance

A shorter course of remdesivir may offer benefits in patients with moderate or severe COVID-19 and a five-to-ten-day course of remdesivir may reduce time to recovery in patients with severe COVID-19. Additional trials are required to determine the potential place for remdesivir as a treatment for COVID-19. Health Canada has approved the use of remdesivir in Canada with specific conditions of use.  

Last Updated: October 21, 2020
Australian guidelines for clinical care of people with COVID-19
— National COVID-19 Clinical Evidence Taskforce
National Guidance

This guidance suggests the use of remdesivir for adults hospitalised with COVID-19 who require oxygen but not ventilation and provides additional information regarding their conditional recommendations. Using hydroxychloroquine, interferon B-1a and lopinavir-ritonavir as a treatment for COVID-19 are not recommended.  

Last Updated: October 27, 2020
Therapeutic Management of Patients with COVID-19
— National Institutes of Health
National Guidance

This guidance provides recommendations for the use of remdesivir and dexamethasone depending on the hospitalization status and oxygen requirements of the patient. 

Last Updated: October 8, 2020
Drugs and vaccines for COVID-19: List of authorized clinical trials
— Government of Canada
National Guidance

This webpage lists authorized clinical trials by Health Canada for COVID-19 drugs, including vaccines. 

Last Updated: October 20, 2020
Treatment for COVID-19
— Harvard Medical School
Professional Organization

This guidance states that most people infected with COVID-19 will be able to recover with adequate rest and hydration. Remdesivir is an antiviral drug that was recently Food and Drug Administration (FDA) approved by the FDA in October 2020 to treat certain hospitalized patients with COVID-19. Many potential treatments for COVID-19 are being investigated such as: convalescent plasma therapy, dexamethasone, chloroquine, hydroxychloroquine, and azithromycin. 

Last Updated: October 22, 2020
Treatments
— BCCDC: British Columbia Centre for Disease Control
Professional Organization Guidance

According to the BCCDC, there is no evidence Tamiflu (oseltamivir) is effective for COVID-19 and there is currently no effective medication for treating COVID-19. 

Last Updated: September 20, 2020
The Effectivity and Safety of Favipiravir Compared to Oseltamivir as Adjuvant Therapy for COVID-19
— Harbuwono et al.
Single Study

This ongoing clinical trial aims to analyze the effectiveness and safety of favipiravir compared to Oseltamivir as an adjuvant therapy among adult COVID-19 patients. 

Last Updated: September 21, 2020
IMU-838 and Oseltamivir in the Treatment of COVID-19 (IONIC)
— Arasaradnam et al.
Single Study

This ongoing clinical trial aims to evaluate whether time-to-improvement is significantly better with MU-838 plus oseltamivir and standard care vs. oseltamivir and standard care in adult subjects with COVID-19. 

Last Updated: August 20, 2020
Favipiravir, Protease Inhibitors, Oseltamivir -Gpo, Hydroxychloroquine for Treatment of COVID-19 (FIGHT-COVID-19)
— Kongsaengdao et al.
Single Study

This ongoing clinical trial aims to evaluate various drug combinations with oseltamivir in mild COVID-19 patients and moderate to critically ill COVID-19 patients. 

Last Updated: August 31, 2020
Coronavirus disease (COVID-19) : Symptoms and treatments
— Government of Canada
Organizational Scan Last Updated: September 22, 2020
Novel Coronavirus (COVID-19) Information for Health Professionals
— City of Toronto
Organizational Scan Last Updated: October 13, 2020
NHI begins large clinical trial to test immune modulators for treatment of COVID-19
— National Institutes of Health
Organizational Scan Last Updated: October 15, 2020
Drawing Closer to COVID-19 treatment breakthrough
— The University of British Columbia Faculty of Medicine
Organizational Scan Last Updated: October 12, 2020
Disclaimer: The summaries provided are distillations of reviews that have synthesized many individual studies. As such, summarized information may not always be applicable to every context. Each piece of evidence is hyperlinked to the original source.

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