Journal of Medical Biomedical and Applied Sciences

J Med Biomed App Sci 8 (4), 358–360 (2020) ISSN (O) 2349-0748

COVID-19: Investigational Drugs

M. Prashanthi Evangelin1 , B. Gopi Krishna2 , S. Yashita Raga3 , SVS. Gopi Raju4 ,
G. Radhika5 , G. Krishna Vamsi6
1 Department of Chemistry, Southern Institute of Medical Sciences
2 Department of Pharmacy, Southern Institute of Medical Sciences
3 Department of Pharmacy, Southern Institute of Medical Sciences
4 Department of Pharmacy, Southern Institute of Medical Sciences
5 Department of Pharmacy, Southern Institute of Medical Sciences
6 Department of Pharmacy, Southern Institute of Medical Sciences

DOI: 10.15520/jmbas.v8i4.218

Accepted 28 March 2020; Received 20 March 2020; Publish Online 1 April 2020

Reviewed By: Dr. ABSTRACT

Daniel V. Coronavirus is a new virus responsible for an outbreak of severe respiratory illness
among humans.This is a zoonotic pathogen which was appeared first in Saudi Arabia
and Jordan. According to WHO report, 858 deaths out of 27 countries were reported
Between April 2012 and December 2019. In the development of viral drugs, the best
target is proteases having specificity and plays an important role in the processing of
viral poly protein. If proper measures were not taken about 90% of worlds population
get infected and 40.6 million would have been killed. So, this present review is focused
on the investigation of drugs.
Key words: Covid–Anti viral–SARS

1 INTRODUCTION
Till date COVID-19 has no drugs either for the prevention
or treatment. Discovering new drugs or therapeutic switch-
ing of an existing drug is a complicated and time-consuming
process. Certain drug categories have been proposed for the
effective treatment of COVID-19 includes antiviral agents,
immunotherapies, and vaccines.332 high-confidence SARS-
CoV-2 human protein-protein interactions are identified by
Gordon et al. Out of these high number of proteins, only 66
human proteins are targeted by 69 existing FDA-approved
drugs, drugs in clinical trials, and/or preclinical compounds.
Up to date research is going on in order to find out the ef-
ficacy of the drugs in SARS-CoV-2 infection. [1]

Figure 1. Structure of Remdesivir

1.1 Antiviral Agents
A nucleotide analog namely remdesivir inFigure 1 (GS-5734;
Gilead Sciences, Inc)which is a prodrug and have been cat-
egorised as a broad spectrum anti-viral agent. This drug
was developed for the treatment of Ebola virus and Mar-
burg virus. Anti-viral activity of this drug can also used
against corona though not proved as it requires more clini-
cal data. [2]
Remdesivir is not only used to inhibit the replication of
severe acute respiratory syndrome coronavirus (SARS-CoV)
in 2003 and Middle East respiratory syndrome coronavirus
(MERS-CoV) in 2012 but also its inhibition capacity has
gained access to treat corona. [3]
Lopinavir/ritonavir
Marmosets and mice infected with MERS-CoV showed
an improvement in clinical parameters by using a regimen
of lopinavir/ritonavirFigure 2 with IFNb2

Figure 2. Structure of Lopinavir/ritonavir
Adult patients (n= 199) with positive SARS- CoV-
2 infection are subjected to randomized, controlled clin-
ical trials whose oxygen saturation should be of 94% or
less/ PaO2 of less than 300 mm Hg and were receiving a
range of ventilatory support modes (eg, no support, me-
chanical ventilation, extracorporeal membrane oxygenation
[ECMO]). Patients added to Standard care(n=99) or stan-
dard care alone (n=100) received. These patients received
lopinavir/ritonavir 400 mg/100 mg PO BID for 14 days in
a randomised fashion. The received groups did not differ in
their clinical outcome and shows lesser mortality rate i.e)
28 days when compared to standard care. [4]
Hydroxychloroquine and chloroquine
Apart from its anti-malarial activity, these are used to
treat auto immune disorders like SLE, Rheumatoid arthri-
tis by showing its immune modulatory effects. Interest-
ingly, due to the inhibition of heme polymerase, they found
a place in antiviral infection treatment. These also in-
hibits the pH-dependent steps of viral replication due to
the alkalinisation of the phagolysosome. Wang et al re-
ported that chloroquine effectively inhibits SARS-CoV-2 in
vitro. [5]Hydroxychloroquine depicted inFigure 3
Figure 3. Structure of Hydroxychloroquine/chloroquine
Azithromycin
Journal of Medical Biomedical and Applied Sciences , Vol 8 Iss 4, 358–360 (2020)
COVID-19: Investigational Drugs 359
A study in France revealed that patients positive to
SARS- CoV-2 are concomitantly suffering from bacte-
rial superinfectionwere exposed to treatment including
azithromycinFigure 4 in 6 patients. Patients who have un-
dergone this treatment had a complete clearance of SARS-
CoV-2. These results must undergo further analysis. Pa-
tients taking combination therapy had lower viral load as
compared to patients taking hydroxychloroquine alone. [6].
Figure 4. Structure of Azithromycin
Nitric oxide
Published findings from the 2004 SARS-CoV infection re-
veals that there is a use in taking inhaled nitric oxide (iNO;
Mallinckrodt Pharmaceuticals, plc) as a supportive measure
for treating infection in patients with pulmonary complica-
tions. Positive improvement in symptoms like pulmonary
hypertension, severe hypoxia, and shortened the duration
of ventilatory support is seen in patients receiving iNO as
compared to matched control patients with SARS. [7]
2 CONCLUSION
Covid-19 is widely distributed in the areas of middle east
countries causing sporadic human disease and reminded in
WHO Blueprint 2020 list of priority. To avoid the further
spread and to reduce the deaths all countries should invest
on research activities and vaccine invention.
REFERENCES
[1] Gautret P, Lagier JC, Parola P, Hoang VT, Meddeb L, Mailhe
M. Hydroxychloroquine and azithromycin as a treatment of
COVID-19: results of an open-label non-randomized clinical
trial. International Journal of Antimicrobial Agents;.
[2] Gordon DE, Jang GM, Bouhaddou M, Xu J, Obernier K,
Mera O, et al. Accessed; 2020. Available from: https://www.
biorxiv.org/content/10.1101/2020.03.22.002386v1.
[3] Cao B, Wang Y, Wen D, Liu W, Wang J, Fan G. A Trial
of Lopinavir-Ritonavir in Adults Hospitalized with Severe
Covid-19. N Engl J Med. 2020;.
[4] Chen L, Liu P, Gao H, Sun B, Chao D, Wang F, et al. In-
halation of Nitric Oxide in the Treatment of Severe Acute
360 M. Prashanthi Evangelin et al.

Respiratory Syndrome: A Rescue Trial in Beijing. Clinical

Infectious Diseases. 2004;39(10):1531–1535. Available from:
https://dx.doi.org/10.1086/425357.
[5] Martinez MA. Compounds with therapeutic potential against
novel respiratory 2019 coronavirus. Antimicrob Agents
Chemother. 2020;.
[6] Mulangu S, Dodd LE, Davey RT, Mbaya OT, Proschan
M, Mukadi D, et al. A Randomized, Controlled Trial of
Ebola Virus Disease Therapeutics. New England Journal
of Medicine. 2019;381(24):2293–2303. Available from: https:
//dx.doi.org/10.1056/nejmoa1910993.
[7] Wang M, Cao R, Zhang L, Yang X, Liu J, Xu M. Remdesivir
and chloroquine effectively inhibit the recently emerged novel
coronavirus (2019-nCoV) in vitro. Cell Res. 2020;.

Journal of Medical Biomedical and Applied Sciences , Vol 8 Iss 4, 358–360 (2020)