I am a doctor and scientist at the University of Virginia. I care about patients and conduct research to find better ways to diagnose and treat infectious diseases, including COVID-19. Here I am sharing what is known about which treatments work, and which don’t, for the new coronavirus infection.
Please note that this field of medicine is rapidly evolving as our understanding of the SARS-CoV-2 virus improves. So what I’m writing today can change in days or weeks.
Below are the treatments that have been tried and for which we have the best knowledge.
Hydroxychloroquine or chloroquine: no evidence that they work
There are three randomized controlled trials of hydroxychloroquine, all of which have failed to prove or disprove a beneficial or deleterious effect on the clinical course of COVID-19 or virus clearance. Given this current lack of evidence, these medications, which are normally used to treat arthritis, should only be used within the context of a controlled clinical trial.
Lopinavir / ritonavir: not helpful
The drug Lopinavir is an inhibitor of an enzyme called HIV protease that is involved in the production of viral particles. Protease inhibitors for HIV were revolutionary, leading to our current ability to effectively treat HIV. Lopinavir can also inhibit enzymes that perform HIV protease-like functions in the SARS and MERS coronaviruses. Ritonavir increases the level of lopinavir in the blood, so the lopinavir / ritonavir combination was tested in a randomized controlled trial for COVID-19.
Unfortunately, there was no impact on virus levels in the throat or duration of virus clearance, nor did it change the clinical course or survival of patients. Therefore, there is no role for lopinavir / ritonavir in the treatment of COVID-19.
Steroids: yes, for almost all COVID-19 patients
When a synthetic steroid hormone, called dexamethasone, was administered to patients with COVID-19, the drug decreased 28-day mortality by 17% and accelerated hospital discharge.
This work was performed in a randomized controlled clinical trial of more than 6,000 patients, and although it was not repeated in another study or not yet reviewed by peers, it is undoubtedly enough evidence to recommend its use.
Tocilizumab: too early to judge
Tocilizumab is an antibody that blocks a protein, called an IL-6 receptor, from binding to IL-6 and triggering inflammation. IL-6 levels are higher in many patients with COVID-19, and the immune system in general appears to be overactivated in those with the more severe disease. This leads many doctors and physicians to think that inhibiting the IL-6 receptor could protect patients from serious disease.
Tocilizumab is currently FDA-approved for the treatment of rheumatoid arthritis and other collagen vascular diseases and for “cytokine storm,” a damaging overreaction of the immune system, which can be caused by certain types of therapy against the cancer and COVID-19.
A retrospective observational study found that COVID-19 patients treated with tocilizumab had a lower risk of mechanical ventilation and death. But we lack a randomized controlled clinical trial, so there is no way to determine if this apparent improvement was due to tocilizumab or the imprecise nature of retrospective studies.
Plasma donated by someone who has recovered from the coronavirus in Bolivia.
AFP via Getty Images
Convalescent plasma: too early to judge
Convalescent plasma, the fluid derived from the blood after the white and red blood cells have been removed, contains antibodies from previous infections that the plasma donor had. This plasma has been used to prevent infectious diseases such as pneumonia, tetanus, diphtheria, mumps, and chicken pox for over a century. It is believed to benefit patients because survivors’ plasma antibodies bind to and inactivate pathogens or their toxins from patients. Convalescent plasma has now been used in thousands of COVID-19 patients.
However, the only randomized clinical trial was small and included only 103 patients who received convalescent plasma 14 days after becoming ill. There was no difference in time to clinical improvement or mortality between those who received and did not receive treatment. The encouraging news was that there was a significant decrease in the levels of viruses detected by PCR.
Therefore, it is too early to know if this will be beneficial and controlled clinical trials are needed.
Remdesivir: yes, it reduces the hospital stay
Remdesivir, performed by Gilead Sciences GILD,
It is a drug that inhibits the coronavirus enzyme that makes copies of the viral RNA genome. It works by causing premature stopping or termination of the copy and ultimately blocking virus replication.
Treatment with remdesivir, especially for patients who required supplemental oxygen before placing them on a ventilator, reduced mortality and shortened the average recovery time from 15 to 11 days.
Read:The United States government will secure the majority of Gilead’s remdesivir supply through September
ACE and BRA inhibitors – keep taking them
There was concern that drugs called ACE inhibitors or angiotensin receptor blockers (ARBs), which are used to treat high blood pressure and heart failure, could increase levels of the ACE2 protein, the SARS receptor. -CoV-2, on the surface of cells in the body. According to the doctors, this would allow more entry points for the virus to infect cells, and therefore increase the severity of new coronavirus infections.
However, there is no evidence that this is the case. The American Heart Association, Heart Failure Society of America, and American College of Cardiology recommend that patients continue to take these medications during the pandemic, as they are beneficial in treating high blood pressure and heart failure.
We have made surprising progress in treating COVID-19. Two therapies, steroids and Remdesivir, have already been shown to help. Those who benefit from these treatments must thank the patients who volunteered to participate in controlled clinical trials and the doctors and pharmaceutical companies that lead them.
William Petri is a professor of medicine at the University of Virginia at Charlottesville. This was first published by The Conversation: “What medications and therapies work, and which don’t, for COVID-19?”
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