PMC:7264098 / 10367-13684 JSONTXT

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{"target":"https://pubannotation.org/docs/sourcedb/PMC/sourceid/7264098","sourcedb":"PMC","sourceid":"7264098","source_url":"https://www.ncbi.nlm.nih.gov/pmc/7264098","text":"Current Treatments Are Palliative Only\nDespite over 300 active and recruiting clinical trials and a number of trials already completed, there is still no robust evidence that any of the investigated therapeutics are effective as treatments for COVID-19 disease (Channappanavar et al., 2017). Equally, there is no evidence to support prophylactic treatment either (Sanders et al., 2020). However, there are only 29 trials in adult patients with placebo-controlled arm (Channappanavar et al., 2017). Various types of pharmacological treatments are currently under investigation including anti-viral, anti-malarial and anti-inflammatory agents. These therapies generally target the following processes: (1) the entry of the virus into host cells, (2) multiplication of the viral genetic material, and (3) immune response/inflammation. Most of these agents have been previously used as treatments for SARS-CoV and MERS-CoV, however the overall conclusions of the meta-analyses published in 2006 and 2018, respectively, did not support the use of any particular regimen. In relation to the meta-analysis of SARS-CoV treatments, the authors systematically reviewed 54 treatment studies, 15 in vitro studies and three ARDS studies (Stockman et al., 2006). Although the combination of ribavirin and interferon-based (IFN) treatments appears the most effective for MERS (Morra et al., 2018), this needs to be confirmed in randomized placebo-controlled trial settings. In terms of vaccines, there are at least 115 vaccine candidates in development with a number of these already initiated in human trials, however we expect vaccines to be available to people under emergency use only in early 2021 (Callaway, 2020; Thanh Le et al., 2020).\nOverall, there are a number of concerns in relation to the design of various trials and interpretation of the data investigating different pharmacological agents for the treatment of COVID-19. Some of these limitations include small cohort sizes, no placebo control arm, lack of considerations for gender, comorbidities, concurrent treatments, route of drug delivery, primary outcomes lacking effects on the viral load or suppression, and adverse drug effects. Whilst most of these therapies represent supportive and symptomatic care, there are a number of adjunctive therapies such as corticosteroids, immunomodulatory, and immunoglobulin agents that have been investigated with limited results. In particular, corticosteroids are not recommended for the management of COVID-19 because of the associated adverse effects, which potentially include increased viral load, secondary infections and complications, similarly to what was observed previously in influenza, SARS-CoV and MERS-CoV infections (Russell et al., 2020). Potential benefits in severe COVID-19 cases are emerging with IL-6 monoclonal antibody, Tocilizumab, and the use of convalescent plasma or hyperimmune immunoglobulins, however better designs and further trials are needed for this to be established (Chen L. et al., 2020; Fu et al., 2020). Nevertheless, none of these therapies are capable of lung tissue repair and regeneration, particularly in those patients with complications such as ARDS, which is why the use of stem cell-based therapies could be beneficial in COVID-19 patients with respiratory 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