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Treatment Options for Coronavirus Disease 2019 in Patients With Reduced or Absent Kidney Function
Hilary Miller-Handley1, Keith Luckett1, Amit Govil1
1Department of Medicine, University of Cincinnati College of Medicine, Cincinnati, OH.
Insights
This review examines coronavirus disease 2019 (COVID-19) treatments, focusing on drug efficacy and dosing in patients with chronic kidney disease (CKD). It highlights the need to include CKD patients in future clinical trials for COVID-19 therapies.
Area of Science:
- Infectious Diseases
- Nephrology
- Pharmacology
Background:
- Coronavirus disease 2019 (COVID-19), caused by SARS-CoV-2, emerged in late 2019.
- Current COVID-19 therapies focus on treatment, not prophylaxis, with ongoing trials for both.
- Effective treatment involves inhibiting viral replication and managing severe immune responses.
Purpose of the Study:
- To review current data on commonly used COVID-19 drugs.
- To discuss factors affecting drug dosing in patients with chronic kidney disease (CKD).
- To emphasize the importance of including CKD patients in clinical trials.
Main Methods:
- Literature review of existing data on COVID-19 treatments.
- Analysis of in vitro antiviral activities versus clinical trial outcomes.
- Examination of pharmacokinetic considerations for CKD patients.
Main Results:
- Many drugs show in vitro antiviral activity, but clinical results are less promising.
- Limited data exists on COVID-19 drug efficacy and dosing in CKD patients.
- Most ongoing clinical trials exclude individuals with impaired kidney function.
Conclusions:
- CKD patients face higher risks for severe COVID-19 outcomes.
- There is a critical need for research on COVID-19 treatments tailored for CKD.
- Future clinical trials must prioritize the inclusion of patients with chronic kidney disease.
Abstract:
Coronavirus disease 2019, the disease caused by the severe acute respiratory syndrome coronavirus 2 virus, was first identified in the Hubei Province of China in late 2019. Currently, the only role for therapy is treatment of the disease, as opposed to postexposure prophylaxis, however multiple clinical trials are currently ongoing for both treatment and prophylaxis. Treating coronavirus disease 2019 relies on two components; the first is inhibition of the viral entrance and replication within the body and the second is inhibition of an exacerbated immune response which can be seen in patients with severe disease. Many drugs have shown in vitro antiviral activity; however, clinical trials have not been as promising. This review summarizes the current data for the most commonly used drugs for coronavirus disease 2019 and will cover the unique factors that may affect the dosing of these medications in patients with CKD. While clinical trials are ongoing, most are in patients with normal kidney function. During a pandemic, when patients with CKD are at higher risk of both infection and death, it is imperative to include patients these patients in the clinical trials.
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