COVID-19 Pandemisinde Kullanılan İlaçlar, Etki Mekanizmaları ve Etkililikleri

Öz

Aralık 2019’ da Çin’ in Wuhan kentinde ortaya çıkan koronavirüs ailesinden olan COVID-19 tüm dünyada pandemiye yol açmıştır. Bu virüsün daha önce SARS-CoV ve MERS-CoV olarak salgın yapmış koronavirüsler ile genetik yakınlığı vardır. COVID-19 hastaları, ciddi akut respiratuvar sendrom (ARDS), ağır pnömoni tablosu, hematolojik bulgular, dissemine intravasküler koagülopati (DIC) ve sepsis gibi ağır tabloların yanısıra koku kaybı, bulantı, kusma, ishal gibi gastrointestinal sistem bulguları ya da sadece cilt döküntüleri ile de hastanelere başvurabilmektedirler. Akut dönemde makrofaj aktivasyon sendromu (MAS) ve sitokin fırtınası sebebiyle ağır inflamasyon tablosuna sebep olmaktadır. Tedavide, SARS-CoV ve MERS-CoV ile oluşan hastalık durumlarında kullanılan ilaçlar denenmektedir. Proflaksi ve tedavide klorokin, hidroksiklorokin kullanılırken ağır pnömoni durumlarında, ilave olarak azitromisin tedaviye eklenir. Hastalığın seyrine göre favipiravir, lopinavir, ritonavir, remdesivir, ribavirin gibi tedavide kullanılan/ denenen ilaçlara yardımcı ilaçlar olarak antisitokin-immunomodulatörler (tosilizumab, anakinra, sarilumab, bevasizumab, ekulizumab), kortikosteroidler, immünoglobilinler, interferonlar ve antiagregan-antiinflamatuvar (dipiridamol) ilaçlar kullanılır. Bu hastalığın seyri sırasında oluşabilecek koagülasyonu önlemek amacıyla profilaktik olarak düşük molekül ağırlıklı heparin (enoksaparin) kullanılabilir. COVID-19 semptomları mevsimsel ve semptomatik nedenlerle influenza ile karışabilir. İnfluenza olması durumunda tedavide oseltamivir kullanılır. Normal şartlarda herhangi bir tedavisi olmayan COVID-19 için aşı ve ilaç çalışmaları hız kazanmıştır. Ancak bu sürecin en az bir yıl kadar sürebileceğini söylemekte yarar vardır. Hatta bu hastalıkla mücadelede kök hücre çalışmaları da yapılmaktadır.

Anahtar Kelimeler

• pandemi
• koronavirüs
• COVİT-19
• , farmakolojik yaklaşımlar

Drugs Used in the Treatment of COVID-19 Pandemic, Their Mechanisms of Action and Efficacy

Öz

COVID-19, which belongs to a coronavirus family that emerged in Wuhan-China in December 2019, has caused pandemics worldwide. This virus has genetic affinity with previous coronaviruses, which have been outbreaks as SARS-CoV and MERS-CoV. COVID-19 patients have severe acute respiratory syndrome(ARDS), severe pneumonia, hematological findings, disseminated intravascular coagulopathy(DIC) and sepsis and also have signs of gastrointestinal system such as loss of smell, nausea-vomiting, diarrhea and sometimes only skin manifestations. In acute period, it causes severe inflammation due to macrophage activation syndrome(MAS) and cytokine storm. In treatment; drugs used in the treatments of SARS-CoV and MERS-CoV, are being tried. While chloroquine/ hydroxychloroquine are used in prophylaxis and treatment, in cases of severe pneumonia, azithromycin is additionally added to the treatment. According to the course of the disease, drugs which are used/being tried at the treatment such as favipiravir, lopinavir, ritonavir, remdesivir and ribavirin could be combined with adjuvant drugs such as anticytokine-immunomodulators (tocilizumab, anakinra, sarilumab, bevacizumab, eculizumab), corticosteroids, immunoglobulines, interferons and antiaggregant drugs (anti-inflammatory drugs) are used as auxiliary drugs. Heparin (enoxaparin) can be used prophylactically, to prevent coagulation in course of this disease. COVID-19 symptoms can be confused with influenza for seasonal and symptomatic reasons. In case of influenza, oseltamivir is used for treatment. Vaccine and drug studies have accelerated for COVID-19, which does not have any treatment under normal conditions. But it would be beneficial to mention that this process may take at least one year. In fact, stem cell studies are also carried out to combat this disease.

Anahtar Kelimeler

• Pandemic, coronavirus, COVID-19, pharmacological approaches

Kaynakça

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