Preliminary data shows that infected COVID-19 patients who were treated with   nonsteroidal anti-inflammatory drugs (NSAIDs) were more likely to experience severe symptoms and had a higher mortality rate than those who didn't take these drugs.  NSAIDs nonselectively block COX1 and COX2, two enzymes that are important in maintaining cardiovascular homeostasis.  It is thought that COX1/2 inhibition may exacerbate the vulnerability of patients with hypertension, diabetes mellitus, or cardiovascular disease to SARS-CoV-2 infection or COVID-19 symptoms.  

Using Nonsteroidal Anti-Inflammatory Drugs (NSAIDs) to Treat or Prevent COVID-19

Preliminary data shows that infected COVID-19 patients who were treated with angiotensin receptor blockers (ARBs) were more likely to experience severe symptoms and had a higher mortality rate than those who didn't take these drugs.  It has been shown that ARBs alter ACE2 expression in those with diabetes mellitus as well as those who have experienced heart failure.  

Using Angiotensin Receptor Blockers (ARBs) to Treat or Prevent COVID-19

Because ACE and ACE2 are structurally similar, it was thought that existing ACE inhibitor (ACE-I) drugs could be used as a COVID-19 treatment by inhibiting ACE2 activity.  However, because the enzymatic binding sites of ACE and ACE2 are different, ACE-Is do not affect ACE2 activity.  Additionally, COVID-19 patients who took ACE-I drugs were more likely to experience more severe symptoms and had a higher mortality rate than those that didn't take them.  It is thought that ACE inhibition in the RAS may exacerbate the vulnerability of patients with hypertension, diabetes mellitus, or cardiovascular disease to SARS-CoV-2 infection or COVID-19 symptoms.

Using ACE Inhibitors (ACE-Is) to Treat or Prevent COVID-19

These are drugs or drug targets that are either ineffective in mitigating COVID-19 or a SARS-CoV-2 infection, or they exacerbate the conditions. 

- ACE inhibitors (ACE-Is)
- angiotensin receptor blockers (ARBs)
- nonsteroidal anti-inflammatory drugs (NSAIDs)

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- effective drug targets and candidates
- ineffective drug targets and candidates
- theoretical drug targets and candidates

Drug Targets and Candidates of COVID-19

- use of existing drugs to mitigate COVID-19
- health behaviors related to COVID-19 drug treatment

Effective COVID-19 Drug Targets and Candidates

Ineffective COVID-19 Drug Targets and Candidates

There are existing drugs that could, in theory, based on their physiological roles, have a positive pharmacological effect on treating or preventing COVID-19.  These drugs may not have been tested yet, or they may have been proved to be ineffective.  

- ACE2 inhibitors
- serine protease inhibitors
- Mas receptor activators
- SARS-S and MERS-S inhibitors 
- soluble ACE2 receptors
- combination therapies
- N-acetylcysteine (NAC)
- antimicrobial peptides
- androgen receptors
- probiotics targeting the gut microbiota
- coronaviral protease inhibitors
- ACE inhibitors + Angiotensin Receptor Blockers (ARBs)
- JAK inhibitors
- Alpha-lipoic acid (ALA)
- Hydrogen Sulfide (H2S)

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