Which drugs have been proven to be effective in COVID-19 and which are not? – St George News

Stock Image | Photo: Cyano66 / iStock / Getty Images Plus, St. George News

Function (conversation) — I am a doctor and scientist at the University of Virginia. I’m doing research to care patients and find better ways to diagnose and treat infectious diseases, including COVID-19. Here we share what is known about effective and ineffective treatments for new coronavirus infections.

Keep in mind that this medical field is evolving rapidly as the understanding of the SARS-CoV-2 virus progresses. So what I’m writing today can change in the days or weeks. Below are the tried and tested cures we are most familiar with.

Hydroxychloroquine or chloroquine-no evidence of their functioning

There were three randomized controlled trials of hydroxychloroquine, none of which could prove or disprove the beneficial or detrimental effects of COVID-19 on the clinical course or clearance of the virus. Given the current lack of evidence, these drugs, which are usually used to treat arthritis, should only be used within the context of controlled clinical trials.

Lopinavir/ritonavir-useless

The drug lopinavir is an inhibitor of an enzyme called HIV protease involved in the production of viral particles. HIV protease inhibitors are innovative and have led to their current ability to effectively treat HIV.

Lopinavir can also inhibit an enzyme that functions similarly to the HIV protease of SARS and MERS coronavirus. The combination of lobinavir and ritonavir was tested in a randomized controlled clinical trial of COVID-19 because ritonavir increases the level of lopinavir in the blood.

Unfortunately, there was no effect on throat viral levels or viral shedding, and no change in patient clinical course or survival. 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 given to patients with COVID-19, the drug reduced the 28-day mortality rate by 17% and accelerated discharge.

This study was conducted in a randomized controlled clinical trial in more than 6,000 patients and has not been replicated in another study or has not been peer reviewed yet, but is sufficient to recommend its use. It is proof.

Tocilizumab-too early to judge

Tocilizumab is an antibody that blocks a protein called the IL-6 receptor from binding to IL-6 and causing inflammation. IL-6 levels are high in many patients with COVID-19 and the immune system generally appears to be over-activated in patients with the most severe diseases. This is what many doctors and doctors Inhibiting the IL-6 receptor can protect patients from serious illness..

Tocilizumab is currently being used to treat rheumatoid arthritis and several other collagen vascular diseases, as well as to treat certain types of cancer and the “cytokine storm” (adverse immune system overreaction) that can be caused by COVID-19. Approved by the FDA.

A retrospective observational study found that COVID-19 patients treated with tocilizumab were at a lower risk of mechanical ventilation and death. However, since there are no randomized controlled trials, there is no way to confirm whether this apparent improvement is due to tocilizumab or the inaccurate nature of the retrospective study.

Convalescent plasma-too early to judge

Convalescent plasma, a liquid derived from blood after the removal of white blood cells and red blood cells, contains antibodies from previous infections received by the plasma donor.

This plasma has been used for over a century to prevent infectious diseases such as pneumonia, tetanus, diphtheria, mumps and chickenpox. Antibodies from survivor plasma are believed to benefit the patient by binding and inactivating the patient’s pathogen or its toxins. Convalescent plasma is currently used by thousands of COVID-19 patients..

However, the only randomized clinical trial was small, with only 103 patients receiving convalescent plasma 14 days after becoming ill. There was no difference in time to clinical improvement or death between treated and untreated patients. The promising news is that the virus levels detected by PCR have dropped significantly.

Therefore, it is too early to determine if this is beneficial and controlled clinical trials are needed.

Rendecibir – yes, reduce hospitalization

Rendescivir is a drug that inhibits the coronavirus enzyme that makes a copy of the viral RNA genome. It works by causing premature termination or termination of the copy, ultimately blocking viral replication.

Rendescivir treatment reduced mortality and shortened mean recovery time from 15 to 11 days, especially for patients who needed supplemental oxygen before being placed on a ventilator.

ACE Inhibitors and ARBs – Continue to take them

There is concern that drugs called ACE inhibitors or angiotensin receptor blockers (ARBs) used to treat hypertension and heart failure increase the level of ACE2 protein, the receptor for SARS-CoV-2 on the surface. did. Cells in the body. This would allow more entry points for the virus to infect cells, as doctors have hypothesized, thus boosting the severity of new coronavirus infections.

However, there is no evidence that this is the case. The American Heart Association, American Heart Failure Association, and American Heart Association recommend that patients continue to take these medications during a pandemic, as they may benefit from the treatment of hypertension and heart failure.

The treatment of COVID-19 has made remarkable progress. Two treatments-steroids and rendecibir-have already been shown to work. The beneficiaries of these treatments are thanks to the patients volunteering to participate in controlled clinical trials and the doctors and pharmaceutical companies that led them.

Written by William Petri, University of Virginia..

This article was republished from Conversation under the Creative Commons License. Read the original article here..

Copyright 2020 The Conversation. all rights reserved. This material may only be published, broadcast or redistributed under The Conversation’s reissue guidelines.