There is no current evidence from randomised clinical trials to recommend any specific treatment for patients with suspected or confirmed COVID-19 infection.
This is an area of active study. Candidate drugs undergoing investigation include remdesivir, lopinavir/ritonavir, chloroquine, interferon, and toculizumab. To date, published clinical data on most of these agents consists largely of in vitro studies, with little or no human data. Hence we do not know whether these medicines benefit or cause harm to patients with COVID-19. One exception is lopinavir/ritonavir, which was studied in a recent randomized control trial of patients with severe COVID-19. No statistically significant benefit was seen with respect to viral load, time to clinical improvement, or mortality. Chloroquine has received considerable interest, given its relatively low cost, (limited) local availability, known side-effect profile (at registered doses), and some promising in vitro data. Published data from human trials is currently lacking. Given the state of evidence, we suggest consideration of the following: 

Where possible, consideration should be given to enroll hospitalized patients in clinical trials. This provides both adequate monitoring and ethics oversight, and affords the opportunity to contribute to the therapeutics evidence base for future patients.

Where investigational therapeutics are given outside of a clinical trial, this should be done under the Monitored Emergency Use of Unregistered Interventions (MEURI) framework, whereby it can be ethically appropriate to offer individuals investigational interventions on an emergency basis in the context of an outbreak characterized by high mortality. The principles of this include:

  • Data providing preliminary support for the intervention’s efficacy and safety are available, at least from laboratory or animal studies.

  • The relevant human research ethics committee has approved the therapeutics’ use.

  • The patient’s informed consent is obtained.

  • Adequate resources are devoted to minimizing the therapeutics’ risk.

  • The results of the intervention are documented and shared with the wider medical and scientific community.

Where therapeutics are given to patients outside of a clinical trial, these should be reserved only for hospitalized patients (rather than given to mild cases, the vast majority of whom will recover fully without any intervention).

Answers extracted from: Clinical management of suspected or confirmed COVID-19 disease (Version 3, 27th March 2020)

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