Clinical manifestations in long-COVID and post-COVID syndromes Terapia 2022, 1 ( 408 ) : 55 - 62
COVID-19 therapeutic options
Summary:
COVID-19 is a disease with a very complex course and multi-system pathology, therefore the therapeutic process is multidirectional. The article covers the treatment of a disease with a typical course. However, the topic of prophylaxis and treatment of complications and consequences that have already been performed has not been discussed.
In the period early after infection with SARS-CoV-2, there is the greatest chance of effective use of antiviral drugs. Until the end of 2021, the only drug with conditional approval from the European Medicines Agency was remdesivir. Currently, such approval has been given for molnupiravir, the monoclonal antibodies of kasirivimab plus imdevimab, and for the use of nirmatrelvir/ritonavir as needed. These drugs should be used within the first five days of the onset of clinical symp-toms or a positive direct test result (PCR or antigen test).
In the period of developed COVID-19 disease with respiratory failure, it is recommended to use drugs that block the immune system ‒ tocilizumab or baricitinib, and glucocorti-coids. Budesonide should be used in the early stages of the disease in the form of inhalation, especially in people whose course of the disease may be severe due to coexisting chronic diseases.
There is a long list of drugs that were initially considered potentially effective, which has not been confirmed in randomized clinical trials, and there is no substantive justification for their use. A large number of studies are currently underway, the results of which may change the current guidelines, so it is obligatory to follow up and update the recommendations.
In the period early after infection with SARS-CoV-2, there is the greatest chance of effective use of antiviral drugs. Until the end of 2021, the only drug with conditional approval from the European Medicines Agency was remdesivir. Currently, such approval has been given for molnupiravir, the monoclonal antibodies of kasirivimab plus imdevimab, and for the use of nirmatrelvir/ritonavir as needed. These drugs should be used within the first five days of the onset of clinical symp-toms or a positive direct test result (PCR or antigen test).
In the period of developed COVID-19 disease with respiratory failure, it is recommended to use drugs that block the immune system ‒ tocilizumab or baricitinib, and glucocorti-coids. Budesonide should be used in the early stages of the disease in the form of inhalation, especially in people whose course of the disease may be severe due to coexisting chronic diseases.
There is a long list of drugs that were initially considered potentially effective, which has not been confirmed in randomized clinical trials, and there is no substantive justification for their use. A large number of studies are currently underway, the results of which may change the current guidelines, so it is obligatory to follow up and update the recommendations.
Keywords: SARS-CoV-2, COVID-19, therapy, remdesivir, monoclonal antibodies, anti-cytokine medication
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