Selective Pressure-Free Treatments for COVID-19
Abstract
:1. Introduction
2. The Challenging Issue of Mutations
3. Antiviral Drugs, Selective Pressure and Drug Resistance
4. Selective Pressure-Free Treatment Methods
4.1. Dexamethasone
- Prolonged use of systemic corticosteroids may increase the risk of reactivation of latent infections (e.g., hepatitis B virus (HBV), herpesvirus infections, strongyloidiasis, tuberculosis).
- The risk of reactivation of latent infections for a 10-day course of dexamethasone (6 mg once daily) is not well defined. When initiating dexamethasone, appropriate screening and treatment to reduce the risk of Strongyloides hyperinfection in patients at high risk of strongyloidiasis (e.g., patients from tropical, subtropical or warm, temperate regions or those engaged in agricultural activities) or fulminant reactivations of HBV should be considered.
- Dexamethasone is a moderate cytochrome P450 (CYP) 3A4 inducer. As such, it may reduce the concentration and potential efficacy of concomitant medications that are CYP3A4 substrates. Clinicians should review a patient’s medication regimen to assess potential interactions.
- Coadministration of remdesivir and dexamethasone has not been formally studied, but a clinically significant pharmacokinetic interaction is not predicted.
- Dexamethasone treatment should continue for up to 10 days or until hospital discharge, whichever comes first.
4.2. Remdesivir
4.3. Hydroxychloroquine
4.4. Lopinavir (Fixed-Dose Combination with Ritonavir)
4.5. Interferon-β1a (Mainly Subcutaneous; Initially with Lopinavir, Later Not)
4.6. Low-Dose Radiation Therapy (LDRT)
5. Discussion
6. Conclusions
Author Contributions
Funding
Acknowledgments
Conflicts of Interest
References
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Low-Dose Radiation Therapy (LDRT) | Dexamethasone (Corticosteroid) | Remdesivir (Antiviral) | |
---|---|---|---|
Main Advantages |
|
| Once daily for up to 9 days |
|
| ||
Disadvantages | Cancer risk increase for doses > 0.5 Gy | Hyperglycaemia that can worsen diabetes | May induce selective pressure on SARS-CoV-2 possibly leading to viral evolution |
Current Limitations |
|
| |
Cost | Moderate | Low | High |
Direct anti-inflammatory effects | ✓ | ✓ | - |
Inhibiting cytokine storm | ✓ | ✓ | - |
Direct anti-virus effects | ✓ | - | ✓ |
Direct anti-bacterial effects | ✓ | May promote bacterial growth (causes superinfection) | - |
Anti-thrombotic Effects | ✓ | - | - |
Tissue repair | ✓ | - | - |
Bone marrow stimulation | ✓ | - | - |
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Mortazavi, A.; Mortazavi, S.M.J.; Sihver, L. Selective Pressure-Free Treatments for COVID-19. Radiation 2021, 1, 18-32. https://doi.org/10.3390/radiation1010003
Mortazavi A, Mortazavi SMJ, Sihver L. Selective Pressure-Free Treatments for COVID-19. Radiation. 2021; 1(1):18-32. https://doi.org/10.3390/radiation1010003
Chicago/Turabian StyleMortazavi, Alireza, Seyed Mohammad Javad Mortazavi, and Lembit Sihver. 2021. "Selective Pressure-Free Treatments for COVID-19" Radiation 1, no. 1: 18-32. https://doi.org/10.3390/radiation1010003