Possibilities for the use of hydroxychloroquine for pre- and postexposure prophylaxis of SARS-CoV-2 infection among exposed contacts and healthcare personnel

There currently exists no published robust data which would confirm effectiveness and safety of hydroxychloroquine in pre- and postexposure prophylaxis of SARS-CoV-2 infection. Taking into account in vitro data, which indicates inhibitory activity of hydroxychloroquine against SARS-CoV-2, and interim guidelines by the Ministry of Health of the Russian Federation, hydroxychloroquine can be considered as postexposure prophylaxis among healthcare personnel who have been in contact with patients with laboratory confirmed SARS-CoV-2, provided no contraindications and significant drug interactions are present. Safety monitoring should be performed before prescribing and during the course of treatment (ECG, total blood count and blood biochemistry, ophthalmologist evaluation before long-term treatment)

Possibility to use barycytinib in patients with COVID-19, including for treatment of «cytokine storm»

Until clinical trials of efficacy and safety are obtained, routine use of barycytinib in patients with COVID-19 cannot be recommended

Current and future use of angiotensin II receptor blockers in patients with COVID-19

No scientific evidence for the negative influence of angiotensin II receptor blockers onto COVID-19 clinical course has been identified so far. Prescribing angiotensin II receptor blockers as COVID-19 pathogenetic therapy could only be considered within clinical trials. Patients who have been taking angiotensin II receptor blockers for approved indications should continue to do so

Possibilities for the use of anakinra in COVID-19

The use of anakinra cannot be currently recommended outside of clinical trials as pathogenetic treatment of “cytokine storm” in severe COVID-19

Anticoagulant deprescribing algorithm in patients with COVID-19 after hospital discharge

We present anticoagulant outpatient deprescribing algorithm in patients with COVID-19 discharged from the hospital. It is reasonable to continue the treatment should the patient have indications for therapeutic anticoagulation. Enhanced prophylaxis of venous thromboembolic complications should be considered in patients with high thromboembolic risk and low risk of bleeding

Possibility to use direct oral anticoagulants to prevent thromboembolic events in patients with COVID-19

Hospitalized patients with COVID-19 who have not previously received DOAK by it is not advisable to prescribe POAC for the prevention of thrombosis in patients with COVID-19 due to the lack of clinical trial results, significant potential interactions

Dexamethasone use in patients with COVID-19

Dexamethasone may be used for mortality reduction in patients with severe COVID-1

Could canakinumab be used for COVID-19?

Use of canakinumab in patients with COVID-19 is currently lacking proper evidence base, and should not be recommended outside of clinical trials

Rationale for use mefloquine for COVID-19 treatment

Currently, the use of mefloquine in patients with COVID-19 does not have sufficient scientific justification and, given the unfavorable efficacy and safety profile, cannot be considered for routine use in clinical practice

Adjusting the role of hydroxychloroquine with or without azithromycin in patients with COVID-19

Taking recent publications into account, one should consider avoiding routine use of hydroxychloroquine, especially if combined with azithromycin, for COVID-19. Such treatment may be associated with the increased risk for hospital mortality and QT prolongation, while there is no documented effectiveness regarding SARS-CoV-2 clearance and outcomes. This treatment may be considered in individual cases, provided potential benefit and risks are carefully weighted, and safety monitoring is enhanced. Hydroxychloroquine safety in outpatients with COVID-19 is poorly studied and risks are increased by challenges in monitoring QT and electrolytes, hence hydroxychloroquine cannot be considered as first line treatment in outpatient settings. Such use of hydroxychloroquine is not recommended if clinical, instrumental, and laboratory monitoring are not in place