These are some of the most promising drugs for covid-19

Remdesivir

The antiviral drug remdesivir was originally developed for the treatment of Ebola, but it has been shown to shorten hospital stays by an average of five days and reduce the number of patients who end up on a ventilator.

The European Medicines Agency (EMA) has already approved remdesivir as a treatment for COVID-19, but more knowledge is needed. One problem is that the drug must be given intravenously as a drip for five days, which means the patient must be hospitalized. Doctors also need more knowledge about when the drug is most favorable to use, says Anders Sönnerborg, professor of clinical virology at the Karolinska Institutet and chair of the reference group for antiviral therapy that has produced an overview of the treatment of covid- 19.

– It is known to have the greatest effect early in the course of the disease when the virus multiplies. But for most people, the disease heals on its own and then antiviral drugs don’t need to be given, he says.

The Medical Products Agency:

– For remdesivir, an effect on recovery time in hospitalized patients has been shown. On that basis, remdeivir has been approved in the EU, says Charlotta Bergquist, group manager for the infection group at the Agency for Medical Products.

Dexamethasone

The cortisone preparation dexamethasone is anti-inflammatory and prevents the immune system from attacking and destroying lung tissue. It has been shown to reduce mortality in severely ill patients and should be used in the later stages of the disease course. If given prematurely, the disease can worsen as it suppresses parts of the immune system that work to fight the virus.

Dexamethasone is already approved in the EU, but even here more knowledge is needed.

– It cannot be ruled out that dexamethasone also has an effect in patients admitted to hospitals who are not seriously ill. Many people receive cortisone even if they are not in the intensive care unit, says Anders Sönnerborg.

The Medical Products Agency:

– It has been shown to have an effect on mortality in hospitalized patients in at least one large study, says Charlotta Bergquist.

Molnupiravir

The antiviral drug Molnupiravir inhibits one of the virus’s enzymes, so it has trouble reproducing itself. It consists of tablets that the patient takes twice a day and is currently being clinically tested in humans. As it is an antiviral drug, it is important to start treatment early. When the preparation may be available in medical care it is difficult to answer.

– If studies are progressing on rails, which is unusual, it is probably in the summer or fall of 2021. If it looks as expected and does not have unreasonable side effects, it can be a “game changer” and reduce the number of patients they end up in the hospital with lung problems. says Anders Sönnerborg.

The Medical Products Agency:

– It is an experimental drug that I cannot comment on, says Charlotta Bergquist.

Monoclonal antibodies

Monoclonal antibodies are mass-produced copies of the body’s own antibodies that bind to virus particles and prevent them from entering cells and multiplying. Several different drugs are being prepared, the most famous being the Regeneron company’s antibody cocktail, Regn-cov2, with which the president of the United States, Trump, was treated when he was ill with covid-19. The advantage is that only one or two injections are required, which could be administered in a health center, says Anders Sönnerborg.

– You’ve come a long way here. Phase 3 studies are underway to see if the side effects are acceptable and the drugs have a clinical effect for patients to improve. Studies will probably be completed by the end of the year or early next. If they work, I assume they will be available in late spring.

Antiviral medications should be taken as soon as possible. A new study shows that monoclonal antibodies have no effect on patients who are cared for in hospital, that is, those who are in an advanced stage of the disease.

The Medical Products Agency:

– There are several experimental drugs that are being evaluated. I don’t dare say much before I have seen the results, but this is not a new idea, monoclonal antibodies are already used against other diseases, says Charlotta Bergquist.

Immunomodulatory drugs

Immunomodulatory medications, such as cortisone, affect the body’s own immune system, but are more personalized. They inhibit the effect of signaling molecules that the body produces in reaction to the virus, in order to prevent the immune system from breaking down lung tissue. Among other things, the drug tocilizumab, which is used in rheumatoid arthritis, is being tested.

– They enter carefully selected specific parts of the immune system, which are known to contribute to the severe harmful immune response in patients with pneumonia. To date, no definitive conclusions have been drawn, except that the side effects are acceptable. Some studies have shown no effect, while others have shown some effect on the course of the disease, says Anders Sönnerborg.

Data indicating whether the agent is useful against covid-19 may arrive early next year.

The Medical Products Agency:

– These are also experimental drugs, where we have not seen any request for approval with the European Medicines Agency. This means that we have not evaluated whether they have been shown to have the desired effect or that it has not yet been possible to demonstrate any effect, says Charlotta Bergquist.

Footnote: Karolinska University Hospital participates in the Molnupiravir study. Anders Sönnerborg participated in the decision to participate, but has no overall responsibility. Karolinska University Hospital is also leading the ImmCoVa study, where, together with other Swedish universities, they are testing various immunomodulatory drugs such as tocilizumab. Anders Sönnerborg participated in the design of the study and is part of the steering group.

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