During a COVID-19 Updates session presented at IDWeek 2023, Jason C. Gallagher, PharmD, clinical professor, Temple University School of Pharmacy, Philadelphia, Pennsylvania, described the current state of COVID-19 treatments. In his presentation titled Update: COVID-19 Therapeutics, Dr. Gallagher covered the latest research, including remdesivir’s efficacy, steroid dosing, metformin in long COVID, and medications in the pipeline as he called for study endpoints to evolve.

Dr. Gallagher began by reporting results of the EPIC-SR study nirmatrelvir to placebo, which evaluated vaccinated high-risk patients and patients without risk factors for poor outcomes. The first outcome is that time to alleviation of symptoms decreased in vaccinated patients, and the second result, he observed, is enhanced prevention of hospitalization/death in nirmatrelvir-vaccinated individuals.

Other recent research results, said Dr. Gallagher, point to better results with lower steroid doses. For example, randomized patients with severe COVID with hypoxemia taking dexamethasone 20 mg versus 6 mg fared worse, he said. “It was kind of mind blowing.”

Also intriguing, he remarked, are the results into the potential benefits of metformin in treating long COVID. Two clinical studies found efficacy in metformin’s role in preventing composite outcomes of hypoxemia, ED visits, hospitalizations, and death.

Yet another study, SBECD, allays earlier concerns over remdesivir in patients with a glomerular filtration rate <30 mL/min, finding that this not a renal safety issue. “There is no mention of renal impairment in remdesivir’s product information,” Dr. Gallagher said.

On the immunomodulators and COVID front, he said that earlier study results are holding up, and the RECOVERY trial points to benefit in sicker patients. The beneficial roles of baricitinib and tocilizumab overlap in severe COVID, and these seem to be holding up to scrutiny, he observed.

Finally, Dr. Gallagher said there “in in fact a pipeline.” He spoke of potential several therapies including entrelsivir, an oral protease inhibitor approved in Japan; bofultrelvir, an oral protease inhibitor in phase III; vilobelimab, an FDA-authorized, anti-C5a antibody for severe COVID; oral remdesivir; obeldesivir in two phase III studies; and bemnifosbuvir, an oral RNA polymerase inhibitor in phase III.