Table 1 Overview of some proposed pharmacological agents with potential beneficial effects in COVID-19 patients.
Pharmacological intervention Conclusion Reference
Antioxidants including Vitamin C and E • Antioxidant effects may ameliorate cardiac injuries of critically ill COVID-19 patients (Wang, Zhang, & Bai, 2020)
Melatonin • May have preventive effect against septic cardiomyopathy
• Has benefits in myocardial infarction, cardiomyopathy, hypertensive heart diseases, and pulmonary hypertension (Zhang et al., 2020)
Anti-interleukin-6 • Tocilizumab (anti-IL-6 receptor), siltuximab (anti-IL-6), and sirukumab (anti-IL-6) are proposed as possible treatments to manage cytokine storm and elevated IL-6 levels (Akhmerov & Marban, 2020; Hendren, Drazner, Bozkurt, & Cooper Jr., 2020; Rizk et al., 2020)
Anti-TNFα • Infliximab, adalimumab, etanercept, golimumab, certolizumab as TNFα neutralizing therapies suggested as potential agents for COVID-19 hyperinflammatory state which may ameliorate organ damage including acute cardiac injury (Convertino et al., 2020)
Janus kinase (JAK) inhibitors • Ruxolitinib, tofacitinib, baricitinib are proposed to be beneficial in controlling excessive IL-6 signaling through STAT-1 and STAT-3 pathways (Alijotas-Reig et al., 2020; Convertino et al., 2020; Richardson et al., 2020; Rizk et al., 2020)
Anti-interleukin-1 • Anakinra, a modified IL-1 receptor antagonist protein, is suggested to have therapeutic potential in cytokine storm, given its effectiveness on patient survival in severe sepsis (Alijotas-Reig et al., 2020; Rizk et al., 2020)
Granulocyte-macrophage-colony stimulating factor (GM-CSF) inhibition • GM-CSF can play a pro-inflammatory role signaling to macrophages
• COVID-19 patients have been demonstrated to have elevated GM-CSF levels
• Literature proposes that targeting GM-CSF upstream of inflammatory cytokines ex. gimsilumab, may be useful to blunt cytokine storm (Rizk et al., 2020)
Statins • Anti-inflammatory properties, including reduction in cytokines, may benefit in COVID-19 hyperinflammatory states in addition to their conventional cardioprotective properties (Alijotas-Reig et al., 2020; Rizk et al., 2020)
ACEi/ARBs • Proposed that treatment with RAAS antagonists may theoretically be beneficial by upregulating ACE2 and compensating for ACE2 receptors lost due to COVID-19 (Akhmerov & Marban, 2020)
N-acetylcysteine (NAC) • Anti-oxidant and anti-inflammatory properties of NAC proposed as an adjuvant therapy for COVID-19 and secondary cardiovascular complications
• Suggested role for NAC in prevention of hypertension, atherosclerosis-associated inflammation, acute heart failure, thrombo-inflammation, and myocardial ischemia (De Flora, Balansky, & La Maestra, 2020; Guglielmetti et al., 2020)
Eicosanoids and soluble epoxide hydrolase (sEH) inhibitors • Epoxyeicosatrienoic acids (EETs) are cardioprotective, anti-inflammatory and pro-resolving
• Inhibition of their metabolizing enzyme, sEH, may be beneficial by maintaining eicosanoid levels and reducing endoplasmic reticulum (ER) stress
• Potential to limit inflammatory storm and resolve inflammation in addition to their established cardioprotective properties
• Co-treatment with sEH inhibitors and omega-3 fatty acids may provide synergistic effects (Hammock, Wang, Gilligan, & Panigrahy, 2020)