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Therapy for Early COVID-19A Critical Need

Educational Objective
To identify the key insights or developments described in this article
1 Credit CME

While coronavirus disease 2019 (COVID-19) is predominantly self-limited, up to 20% of symptomatic individuals will progress to severe or critical disease with clinical manifestations including pneumonia, acute respiratory distress syndrome, multiorgan system dysfunction, hypercoagulation, and hyperinflammatory manifestations. There have been more than 47 million cases of COVID-19 globally resulting in more than 1.2 million deaths. Additionally, a growing body of data suggests that some patients with COVID-19, including individuals with mild symptoms, will have a variably prolonged course of recovery including fatigue, cognitive impairment, and cardiopulmonary dysfunction.1 While treatment options for patients with severe disease requiring hospitalization are now available, with corticosteroids emerging as the treatment of choice for critically ill patients, interventions that can be administered early during the course of infection to prevent disease progression and longer-term complications are urgently needed.2,3

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Article Information

Corresponding Author: Peter S. Kim, MD, Therapeutics Research Program, Division of AIDS, National Institute of Allergy and Infectious Diseases, National Institutes of Health, 5601 Fishers Ln, Bethesda, MD 20892 (peter.kim2@nih.gov).

Published Online: November 11, 2020. doi:10.1001/jama.2020.22813

Conflict of Interest Disclosures: Dr Kim reported serving as the National Institutes of Health (NIH) lead for the ACTIV-2 trial but has no financial relationship with the trial. No other disclosures were reported.

Additional Information: Dr Kim is Director of the Therapeutics Research Program in the Division of AIDS (DAIDS) of the National Institute of Allergy and Infectious Diseases (NIAID) at the NIH; Dr Read is Deputy Director of DAIDS; and Dr Fauci is Director, NIAID.

References
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2.
Prescott  HC , Rice  TW .  Corticosteroids in COVID-19 ARDS: evidence and hope during the pandemic.   JAMA. 2020;324(13):1292-1295. doi:10.1001/jama.2020.16747PubMedGoogle ScholarCrossref
3.
Sterne  JAC , Murthy  S , Diaz  JV ,  et al; WHO Rapid Evidence Appraisal for COVID-19 Therapies (REACT) Working Group.  Association between administration of systemic corticosteroids and mortality among critically ill patients with COVID-19: a meta-analysis.   JAMA. 2020;324(13):1330-1341. doi:10.1001/jama.2020.17023PubMedGoogle ScholarCrossref
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Beigel  JH , Tomashek  KM , Dodd  LE ,  et al; ACTT-1 Study Group Members.  Remdesivir for the treatment of COVID-19: final report.   N Engl J Med. Published online October 8, 2020. doi:10.1056/NEJMoa2007764PubMedGoogle Scholar
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The RECOVERY Collaborative Group.  Dexamethasone in hospitalized patients with COVID-19: preliminary report.   N Engl J Med. Published online July 17, 2020. doi:10.1056/NEJMoa2021436Google Scholar
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Abella  BS , Jolkovsky  EL , Biney  BT ,  et al; and the Prevention and Treatment of COVID-19 With Hydroxychloroquine (PATCH) Investigators.  Efficacy and safety of hydroxychloroquine vs placebo for pre-exposure SARS-CoV-2 prophylaxis among health care workers: a randomized clinical trial.   JAMA Intern Med. Published online September 30, 2020. doi:10.1001/jamainternmed.2020.6319PubMedGoogle Scholar
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Chen  P , Nirula  A , Heller  B ,  et al; BLAZE-1 Investigators.  SARS-CoV-2 neutralizing antibody LY-CoV555 in outpatients with COVID-19.   N Engl J Med. Published online October 28, 2020. doi:10.1056/NEJMoa2029849PubMedGoogle Scholar
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Regeneron. Regeneron’s REGN-COV2 antibody cocktail reduced viral levels and improved symptoms in non-hospitalized COVID-19 patients [news release]. Published September 29, 2020. Accessed October 15, 2020. https://investor.regeneron.com/news-releases/news-release-details/regenerons-regn-cov2-antibody-cocktail-reduced-viral-levels-and
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