Pharmacology and Adverse Events of Emergency-Use Authorized Medication in Moderate to Severe COVID-19

Some effective drugs have been approved or issued an Emergency Use Authorization for the treatment of COVID-19 in hospitalized patients, but post-market surveillance is warranted to monitor adverse events. We reviewed clinical trials and case reports in patients with moderate-to-severe COVID-19 infe...

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Bibliographic Details
Published in:Pharmaceuticals (Basel, Switzerland) Switzerland), 2021-09, Vol.14 (10), p.955
Main Authors: Hsu, Jen-Yu, Mao, Yan-Chiao, Liu, Po-Yu, Lai, Kuo-Lung
Format: Article
Language:English
Subjects:
Adenosine triphosphate
adverse event
baricitinib
Clinical trials
Coronaviruses
COVID-19
Disease
Drug dosages
Drug interactions
Dyspnea
FDA approval
Hospitalization
Infections
Kidneys
Liver
Pharmacokinetics
Plasma
remdesivir
Review
RNA polymerase
sarilumab
Severe acute respiratory syndrome coronavirus 2
Steroids
tocilizumab
Toxicity
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Summary:Some effective drugs have been approved or issued an Emergency Use Authorization for the treatment of COVID-19 in hospitalized patients, but post-market surveillance is warranted to monitor adverse events. We reviewed clinical trials and case reports in patients with moderate-to-severe COVID-19 infection who received remdesivir, baricitinib, tocilizumab, or sarilumab. The drug-specific pharmacokinetics, toxicity, and drug interactions are summarized in this study. Remdesivir and baricitinib are small-molecule drugs that are mainly metabolized by the kidneys, while tocilizumab and sarilumab are monoclonal antibody drugs with metabolic pathways that are currently not fully understood. The most common adverse events of these drugs are alterations in liver function, but serious adverse events have rarely been attributed to them. Only a few studies have reported that remdesivir might be cardiotoxic and that baricitinib might cause thromboembolism. Biological agents such as baricitinib, tocilizumab, and sarilumab could inhibit the pathway of inflammatory processes, leading to immune dysregulation, so the risk of secondary infection should be assessed before prescribing. Further recognition of the pathogenic mechanism and risk factors of adverse events is essential for optimizing treatment strategies.
ISSN:1424-8247
1424-8247
DOI:10.3390/ph14100955