Coronavirus treatments: some progress, no panacea

Almost a year after a mysterious pneumonia emerged in China and began its global spread, there is still no miracle treatment for COVID-19 despite an unprecedented effort to discover new drugs or reuse existing drugs.

A single family of inexpensive and widely available drugs – corticosteroids – has proven its effectiveness, but some other drugs that were initially advertised have disappointed.

What works?

Dexamethasone:

This is the only treatment that has reduced COVID-19 mortality, although it has been shown to only work for seriously ill patients in the hospital and in need of oxygen therapy.

The World Health Organization (WHO) and the European Medicines Agency (EMA) have been recommending dexamethasone for these patients since September, based on the results of a large British clinical trial called Recovery.

Dexamethasone can actually inhibit the immune system, so it shouldn’t be given to those in the early stages of the disease.

But this is why it works in those who are very ill: it works to tame an uncontrolled immune response, which can trigger the inflammation typical of severe forms of the disease.

And it seems like it’s not just dexamethasone.

Research published in early September in the American medical journal Jama showed that other drugs in the same corticosteroid family could also be effective, reducing mortality by 21% after 28 days for patients with severe COVID-19.

This has led WHO to recommend the “systematic” use of corticosteroids in critically ill and critically ill patients.

Anticoagulants:

Like corticosteroids, these drugs are used only in the most seriously ill patients. The goal is to prevent blood clots from forming, one of the serious complications of COVID-19.

What doesn’t work well enough

Remdesivir:

For a while this antiviral treatment had the world’s hopes for it.

The drug, developed for Ebola, was initially thought to be very promising.

The European Commission announced it had ordered 500,000 doses in October, while the United States granted it permanent authorization for use.

Its manufacturer, US pharmaceutical giant Gilead, said the drug increased Q3 2020 sales by nearly $ 900 million (€ 756 million).

But it didn’t live up to expectations.

On November 20, WHO said that remdesivir should not be used to treat patients with COVID-19, regardless of the severity of their disease, stating that it had no “major effect” on survival chances.

This does not mean that it has proven ineffective, but rather that it has not been shown to improve patient outcomes.

There were also concerns about possible side effects, particularly on the kidneys, as well as the cost of the drug.

The WHO advice was based on four international randomized clinical trials involving more than 7,000 hospitalized patients with COVID-19.

What doesn’t work at all

Hydroxychloroquine:

This drug has become a lightning rod for the politicized debates on the pandemic.

Used as a treatment for malaria or autoimmune diseases, depending on the country, hydroxychloroquine has been touted as a kind of miracle cure by its supporters, most notably US President Donald Trump, despite the lack of evidence that it worked.

Among scientists, controversial French professor Didier Raoult has spoken out in favor of the drug.

Hydroxychloroquine was at the center of an academic scandal when the prestigious medical journal The Lancet had to withdraw a study suggesting adverse effects of the drug after concerns were raised about the underlying data.

The retraction of critical hydroxychloroquine research has only served to galvanize advocates of the drug.

But study after study showed it’s not effective against COVID-19, including the UK’s Recovery study, the results of which were published in New England Journal of Medicine in October.

Lopinavir-ritonavir:

Used against HIV, the virus that causes AIDS, this one-two antiviral punch has proven ineffective in treating COVID-19 in the hospital setting, according to the Recovery study, which published its results in The Lancet in October.

Still under investigation

Tocilizumab:

Scientists hope that this immunosuppressant, currently used against rheumatoid arthritis, will be able to prevent potentially life-threatening inflammation in severe cases.

So far, however, studies have not yet provided a definitive answer.

Researchers from Imperial College London announced on November 19 that tocilizumab appeared to have a beneficial effect, according to preliminary results from their clinical trial.

The large-scale recovery test could reveal more in the coming weeks.

Synthetic antibodies:

When the body fights viruses like SARS-CoV-2, it develops antibodies, proteins programmed to target specific pathogens.

These antibodies can be synthesized in the laboratory and could theoretically be administered to COVID-19 patients to boost their natural immune response.

Trump received this still-experimental treatment, produced by the American biotech company Regeneron, when he was hospitalized with the virus.

This treatment, and one of the same type manufactured by Eli Lilly, has received authorization for emergency use in the United States.

But their effectiveness continues to be evaluated, with the Regeneron treatment included in the Recovery study.

Plasma:

Plasma drawn from the blood of cured patients has shown some initial promise when administered intravenously to people with COVID-19.

It has already been shown to help accelerate recovery from Ebola and SARS, which is caused by the same family of pathogens as the new coronavirus.

Recovery has an ongoing clinical trial for plasma treatment.

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© 2020 AFP