我听说有几种药物被认为是治疗 COVID-19 的可能方法。是哪些药物,它们的效果如何?
回答 Daniel C. DeSimone, M.D.
FDA 已批准抗病毒药瑞德西韦(Veklury)用于治疗 COVID-19 成人患者和 12 岁及以上的儿童患者。对于需要辅助供氧或患重症风险较高的 COVID-19 住院患者,可为其开具瑞德西韦。此药物通过皮肤注射(静脉)给药。
Paxlovid 是另一种获批用于治疗 COVID-19 成人患者的药物。其中含有奈玛特韦(阻断 COVID-19 致病病毒复制所需特异酶活性的药物),以及利托那韦(帮助减缓奈玛特韦分解的抗病毒药物)。Paxlovid 继续获得紧急使用授权,用于治疗 12-18 岁且患重症风险较高的轻度至中度 COVID-19 患者。该药物为口服药片。
FDA 已批准治疗类风湿关节炎的药物巴瑞替尼 (Olumiant)和托珠单抗 (Actemra)在某些情况下用于治疗 COVID-19。巴瑞替尼药片似乎是通过减轻炎症和发挥抗病毒活性来对抗 COVID-19。托珠单抗是注射药物。托珠单抗似乎是通过消炎来对抗 COVID-19。两种药物均可用于正在使用机械呼吸机或需要辅助供氧的 COVID-19 住院患者。
获批使用
FDA 已批准莫诺拉韦的紧急使用许可。这是一种抗病毒药物,用于治疗患重症风险较高且无法采用其他治疗方案的轻度至中度 COVID-19 成人患者。该药物为口服药片。
研究者正在研究 COVID-19 的其他潜在治疗方法,包括:
- 抗病毒药物。研究人员正进行抗病毒药物法维拉韦和美泊地布的试验。研究发现,洛匹那韦与利托那韦联用无效。
- 抗炎疗法。研究人员研究了多种抗炎药物,以治疗或预防感染相关发炎引起的多器官功能障碍和肺损伤。
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地塞米松。皮质类固醇地塞米松是研究人员目前正在研究的一种抗炎药,用于治疗或预防发炎引起的器官功能障碍和肺损伤。多项研究发现,此药可将使用呼吸机的患者的死亡率降低约 30%,将需要辅助供氧的患者的死亡率降低约 20%。
美国国立卫生研究院建议因 COVID-19 住院且正在使用机械呼吸机或需要辅助供氧的患者使用地塞米松。如果没有地塞米松,可使用其他皮质类固醇,例如泼尼龙、甲泼尼龙或氢化可的松。对于不太严重的 COVID-19 感染,地塞米松和其他皮质类固醇可能有害。
在某些情况下,对于正在接受机械呼吸机或需要辅助供氧的住院患者,瑞德西韦、托珠单抗或巴瑞替尼可与地塞米松联用。
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免疫疗法。研究人员正在研究免疫疗法,包括恢复期血浆和间充质干细胞。恢复期血浆是指 COVID-19 康复患者捐献的血液。高抗体水平的恢复期血浆可用于治疗部分处于疾病早期或免疫系统低下的 COVID-19 住院患者。FDA 已批准使用恢复期血浆疗法治疗 COVID-19 的紧急使用许可。
经 FDA 批准,免疫系统阻抑药物阿那白滞素可以用于需要辅助供氧的患者。
研究人员还在研究在实验室中制造的蛋白质单克隆抗体。它们可以帮助免疫系统清除病毒。FDA 批准单克隆抗体韦洛利单抗用于正在接受机械通气或体外膜氧合(称为 ECMO)的患者。
- 当前处于研究中且有效性不明确的药物。研究人员正在研究氨氯地平和氯沙坦。但目前尚不清楚这些药物在治疗或预防 COVID-19 方面的有效性。认为法莫替丁对于治疗 COVID-19 无益。
- 伊维菌素。伊维菌素这种药物用于治疗或预防动物和人体寄生虫,不用于治疗病毒。FDA 尚未批准使用该药来治疗或预防 COVID-19。大量服用这种药物可能造成严重伤害。请不要在您自己身上使用兽用药物,试图以此治疗或预防 COVID-19。
- 羟氯喹和氯喹。FDA 曾在 COVID-19 疫情期间授权紧急使用这些抗疟疾药物。但是数据分析显示这些药物治疗 COVID-19 的疗效不佳,因此 FDA 撤回了授权。另外,这些药物还可能引起严重的心脏问题。
预防 COVID-19 的药物。研究者正在研究在接触病毒前后预防 COVID-19 的药物。
目前尚不清楚这些药物是否对 COVID-19 有效。完成医学研究以确定这些药物是否对 COVID-19 有效至关重要。
即使您听说这些药物可能有效,也切勿在没有处方和医务人员批准的情况下尝试这些药物。这些药物可能会产生严重的副作用。仅供在医务人员监护下的重症患者使用。
With
Daniel C. DeSimone, M.D.
Jan. 05, 2024
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