Evidence of the clinical efficacy of antiviral agents against SARS-CoV-2

Abstract

The highly transmissible SARS-CoV-2, the virus that causes COVID-19, typically induces atypical pneumonia in humans by replicating in the lower and upper respiratory tract. It may also infect gastrointestinal and cardiovascular tissue, where its key binding receptor, ACE2 is located. Numerous treatment strategies have been investigated and repurposed to mitigate the potentially serious clinical outcomes of the COVID-19 pandemic. Yet there is currently no definitive treatment for this disease. This literature review examined the published clinical evidence of potential anti-SARS-CoV-2 antiviral drug efficacy in terms of reducing viral load, recovery time, hospitalization time, mechanical ventilation, and case fatality rates in COVID-19 patients. It was found that remdesivir, the FDA-approved antiviral for severe illness, shows suboptimal efficacy, that neutralizing antibodies including bamlanivimab/etesevimab, casirivimab/imdevimab, and CT-P59 demonstrate clinical efficacy, particularly in reducing SARS-CoV-2 viral loads and curbing hospitalization and death, and that antivirals such as favipiravir, sofosbuvir/daclatasvir, and nitazoxanide may harbor potential efficacy. Nafamostat-mesylate and novaferon require further investigation to validate promising early findings. In conclusion, definitive treatments of COVID-19 remain elusive, but numerous antiviral strategies including remdesivir and neutralizing antibodies may temper COVID-19. Prevention of COVID-19 may be achieved by vaccination, but only a small proportion of the global population is inoculated. Therefore, ongoing research on anti-SARS-CoV-2 treatment is required.