2020 challenge: the potential options of COVID-19 therapy

Abstract

Background. Coronavirus disease (COVID-19) is a new disease, and there is no vaccine, specific drugs and treatment protocols. In 15-20 % of patients the course is severe course, and 4 % of cases are fatal. 15 % of adults infected with the SARS-CoV-2 coronavirus develop pneumonia. In 5 % pneumonia progresses to a critically severe condition with the development of respiratory failure and acute respiratory distress syndrome. Objective. To describe the potential options of COVID-19 therapy. Materials and methods. Analysis of literature sources on this topic and the own clinical study, which involved 60 patients with COVID-19 (main and control groups, standardized by age and sex). In the control group, standard treatment was prescribed, and in the main group – basic therapy and Ksavron tid, Tivorel once a day and Reosorbilact once a day (all medications – by “Yuria-Pharm”). Results and discussion. Antiviral drugs (nelfinavir, remdesivir, favipiravir), recombinant human monoclonal antibodies to interleukin-6 receptors tocilizumab, and chloroquine-related drugs (sometimes in combination with azithromycin) are used for COVID-19 pharmacotherapy. Usage of edaravone (Ksavron) to inhibit the cytokine storm and of Reosorbilact to reduce the incidence of pulmonary complications, the duration of mechanical ventilation, and the volume of infusions has a great potential. The use of the latter is especially appropriate under the conditions of restrictive infusion regimen. In addition, L-arginine and L-carnitine (Tivorel) can be used. L-arginine reduces spasm of smooth bronchial muscles and improves the vasomotor function of the pulmonary endothelium. L-carnitine has anti-inflammatory and immunomodulatory effects. The own study found out that the level of C-reactive protein in the main group (standard therapy + Ksavron, Tivorel and Reosorbilact) has decreased from 39.45 to 7.5 mg/L, and in the control group – from 46.26 to 12.50 mg/L, indicating a more pronounced reduction of inflammation in the main group. In addition, the content of D-dimer and ferritin decreased more markedly in the main group (by 24.1 % and 27.1 % respectively). The additional pathogenetic treatment listed above helped to improve blood oxygen saturation, reduce the number of leukocytes and decrease the length of hospital stay. Conclusions. 1. Antiviral drugs, tocilizumab, chloroquine-related drugs, and azithromycin are used to treat COVID-19. 2. Potential treatment options include the usage of Ksavron, Reosorbilact and Tivorel. 3. According to own research, the inclusion of these drugs into the combined therapy reduces the activity of the inflammatory process in the lungs and counteracts the tendency to thrombosis.