COVID-19 outbreak: Challenges in pharmacotherapy based on pharmacokinetic and pharmacodynamic aspects of drug therapy in patients with moderate to severe infection.
Parisa Ghasemiyeh, Soliman Mohammadi-Samani
PMID 32980626WHAT IT FOUND
Drug effects are uncertain and mixed: hydroxychloroquine/chloroquine are no longer recommended by FDA, remdesivir and lopinavir/ritonavir did not clearly improve outcomes, and dexamethasone may reduce mortality in patients needing respiratory support.
Key findings
01The review says chloroquine and hydroxychloroquine are no longer recommended by the FDA because their risks could outweigh potential benefits, and a meta-analysis of 53 randomized clinical trials found hydroxychloroquine had higher total adverse effects than placebo or no treatment.
02A randomized, double-blind, placebo-control trial in China found remdesivir was not significantly associated with shorter recovery time or clinical benefit, although a compassionate-use cohort reported improvement in about 68% of patients and the FDA had approved emergency use.
03Dexamethasone could reduce the mortality rate to one-third and one-fifth in COVID-19 patients on ventilators and supplemental oxygen respectively, but it did not show significant benefit in patients who did not require respiratory support.
STILL TO COME
How it was doneWhat they foundWhat it means for RNs
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What it does not show
No original methods or results are reported; this is a narrative review. It combines different kinds of evidence, including in vitro findings, case reports, pilot studies, non-randomized trials, cohorts, and guideline statements. Several drug statements are explicitly limited by small samples, heterogeneity, or unresolved safety concerns. The review mixes potential benefits with serious adverse effects and does not provide a tested treatment algorithm for any single discipline.
The easy way to misread this
Do not read this review as proof that any listed drug treats COVID-19. The paper itself says chloroquine/hydroxychloroquine evidence is weak and controversial, remdesivir and lopinavir/ritonavir did not clearly improve outcomes, and several studies were small or non-randomized.