What are the main drugs under investigation that block
SARS-CoV-2 replication?
Drugs designed to inhibit the viral replication machinery may be
effective against SARS-CoV-2. For example, remdesivir inhibits viral RNA
polymerases, which prevents SARS-CoV-2 replication. In a cohort of
severe COVID-19 patients, compassionate-use of remdesivir showed
clinical improvement in 68% of patients (36 out of
53).186 Of note, a double-blind, randomized,
placebo-controlled trial of intravenous remdesivir was conducted in
1,063 adults hospitalized with COVID-19 with evidence of lower
respiratory tract involvement; remdesivir was superior to placebo in
shortening the time to recovery in adults hospitalized with COVID-19 and
evidence of lower respiratory tract infection.187Furthermore, in a study of 5 HIV-positive hospitalized patients with
severe COVID-19, 3 of them were given lopinavir-boosted ritonavir and 2
darunavir-boosted cobicistat for 14 days. Four patients recovered and 1
remained hospitalized.188 In another study with 99
hospitalized adult patients with severe COVID-19, no benefit beyond
standard care was observed with lopinavir-boosted ritonavir treatment
twice daily for 14 days.189 It is uncertain whether
lopinavir-boosted ritonavir and other antiretrovirals improve clinical
outcomes or prophylaxis among patients at high risk of SARS-CoV-2
infection.190 Additional potential candidates include
other broad-spectrum antiviral drugs such as arbidol and favipiravir and
phytochemicals with anti-viral activity such as resveratrol
(Figure. 1 ).183