Treatment & Therapeutics
An unprecedented public health crisis has led to an unprecedented global response - Bayer.com
...There’s a long road ahead before everyone is vaccinated—around the world, not just in the United States—but the good news for those who get COVID-19 between now and then is that we know more about treating the disease now than we did in the early months of the pandemic. Here’s a breakdown of the best treatments we have for COVID-19.
Some of the most promising COVID-19 treatments have relied on giving the patient’s own immune system a boost using antibodies from other people.
Once someone is exposed to a pathogen, their immune system tries to develop antibodies against it, but the process of developing one’s own antibodies can take some time. Adding antibodies from another source to the bloodstream can buy that time. Doctors have been using plasma, the liquid part of blood, and the part that contains antibody proteins against COVID-19 for this purpose. This so-called convalescent plasma is drawn from people who have already had the disease (hence the name).
Convalescent plasma contains more than just COVID-19 antibodies, which means it’s not the strongest treatment. A small but well done clinical trial performed in Argentina and published in The New England Journal of Medicine in early January found that if the treatment is given within days of start of illness, the treatment does prevent older adults from getting severe COVID-19.
In the meantime, researchers have been working to supercharge the immune system using lab-made COVID-19 antibodies, called monoclonal antibodies, that can shore up a patient’s immune system ahead of its own antibodies. Two companies, Eli Lilly and Regeneron, have been granted an Emergency Use Authorization (EUA) by the Food and Drug Administration for their monoclonal antibodies.
But monoclonal antibodies aren’t a cure. Their use is only recommended for people who are newly infected with SARS-CoV-2 to help keep the disease from taking root. In a Nature Biotechnology commentary from October, a panel of experts note these treatments are hard to develop and are generally used mostly for diseases that we don’t have vaccines for, like HIV. In the case of COVID-19, they note, monoclonal antibodies may prove most useful to help people who don’t respond to a vaccine—for example, older adults with weakened immune systems—since they may still be susceptible after the rest of the population is immunized.
A recent study published in January 2021 in Science gave nursing home residents a single infusion of Eli Lily’s monoclonal antibodies at four times the typical dose and found that the antibodies reduced the risk of becoming ill with COVID-19 over a period of two months by 57 percent. The trial involved 1000 nursing home residents and half the participants received a placebo. Its unclear how this could fit in, given the continued expansion of vaccines in nursing homes as a way to prevent COVID-19.
Antivirals work by targeting virus’ ability to infect other cells. In early December, the World Health Organization released results from a large-scale trial of three antivirals: remdesivir, hydroxychloroquine, and lopinavir. Its results led the international organization to conclude that the drugs had “little or no effect on hospitalized patients with COVID-19.”
Remdesivir, the most widely used drug of this class in treating COVID-19, works by blocking an enzyme that SARS-CoV-2 uses to replicate itself. Remdesivir was initially designed to combat Ebola, and although it didn’t prove effective for that disease, the Ebola studies demonstrated that the drug was at least not harmful to humans.
Back in October of 2020, the FDA officially approved remdesivir to treat COVID-19, making it the first drug to be green-lit to treat the disease (after being given emergency-use authorization in May). Despite this regulatory success, studies have not shown equal achievement. Even the most robust studies showed no evidence that remdesivir prevents deaths from the novel disease.
Further, another tricky thing about antivirals in general is that they often have serious side effects, since the mechanism of action they’re blocking isn’t always unique to a virus. It might be something your cells need to do as well. Take, for example, hydroxychloroquine and chloroquine, potent antimalarials that have been shown to be ineffective against COVID-19. These drugs work by impairing a part of the cell called the lysosome, which basically breaks down and gets rid of cellular garbage. In the single-celled parasite that causes malaria, messing up its lysosome kills it. But these drugs also screw with the lysosomes inside your cells too, which accounts for the serious side-effects they have. They’re only recommended for use in cases where the benefits of the treatment outweigh the harmful side-effects. For these reasons, on March 2, the World Health Organization strongly advised against using hydroxychloroquine to treat COVID-19 for all patients.
A few other antivirals are also being investigated, including Favipiravir and Ivermectin. Favipiravir is still being studied for use against COVID-19. It’s been approved for use by some countries, including India. But we’re still learning more about its effectiveness and the FDA has not yet approved it. Ivermectin, on the other hand, showed some early intrigue by researchers but ultimately did not pan out; one study found that at a high dosage level it killed SARS-CoV-2 cells in a petri dish, but that dosage could be lethal to humans. A similar version of Ivermectin is used to prevent heartworm in dogs, and is relatively available to get. As such, the FDA has issued warnings, the latest one on March 5, 2021, not to use Ivermectin to treat or prevent COVID-19.
Steroids like dexamethasone have been used to treat the worst effects of COVID-19 by reducing the body’s own immune response. They’re effective in preventing the potentially life-threatening inflammation that results from severe infection and that can cause Acute Respiratory Distress Syndrome (ARDS), which is a main cause of COVID-19 fatalities.
But just like antivirals, sometimes the side effects from steroids can actually make things worse. Since steroids suppress the immune system, they can also make it harder for your body to fight off a COVID-19 infection. The trick is in knowing when they can be more helpful than harmful, and which dose is best. Here again, research is ongoing, but trials earlier in the year demonstrated that steroids definitely can help in treating the most severely affected COVID-19 patients.
Other medications that influence the immune system
The immune system plays a key role in how a person responds to an infection with a virus like SARS-CoV-2. As such, other drugs that influence the immune response, though not steroids, have also been looked into for preventing the overwhelming inflammation that often accompanies an infection with the novel coronavirus. In particular, researchers have been looking at drugs that dampen down the release of cytokines, proteins that the body produces en masse to fight off an infection. Doctors and other researchers have been finding that overproduction of these proteins can often contribute to severe COVID-19.
One drug, called Baricitinib, which is approved by the FDA to treat rheumatoid arthritis, has been investigated when used in conjunction with remdesivir, though the results were modest at best. Those who benefited most were on high-flow oxygen, not ventilation. For that group Baricitinib and remdesivir, taken together, shorten recovery time from 18 days to 10 days.
Another, called Tocilizumab and also approved to treat rheumatoid arthritis, seemed promising early on as well but recent investigations were mixed. A study published in January in The New England Journal of Medicine found that among a group of COVID-19 patients hospitalized with pneumonia but not on a ventilator, Tocilizumab reduced their chances of needing a ventilator from approximately 1 in 5 to about 1 in 10, though it did not improve overall survival rates.
A whole host of other treatments have been tried for COVID-19, but they have either not proven themselves to be effective in clinical trials, their results were modest at best, or different trials showed mixed results. Recently, that’s been true for the antibiotic, Azithromycin (also called a z-pack), which is designed to treat bacterial infections but also been found to reduce inflammation overall, which researchers hoped could help with the extreme inflammation response seen in severe COVID-19. However, according to The New York Times, a large, double-blind clinical trial found no benefit of the antibiotic in hospitalized COVID-19 patients.
Vitamins, especially Vitamin D and zinc, have also gotten a considerable amount of media coverage throughout the pandemic, but taken as a whole, the results are a mixed bag. For Vitamin D, there has yet to be a decent clinical trial to show that supplementation with Vitamin D helps COVID-19 or that low Vitamin D levels mean you are more likely to get severe COVID-19. For now, if you are low on Vitamin D, its important to talk to your doctor and supplement if needed, but there’s nothing that can be definitively said about the vitamin’s connection to COVID-19.
Two methods that are non-pharmacological but do work are ventilators, which help provide needed oxygen, and a technique known as proning, or prone positioning, in which patients with severe respiratory illnesses are positioned on their ventral (belly) side. This placement helps keep their lungs open.
Even as our methods have advanced, the best route is still to try and avoid getting sick if at all possible. Wear a mask, maintain social distance, wash your hands, and stay at home as much as possible. A vaccine is coming—we just need to keep each other safe until then.
Source: Kat Eschner, The best treatments we currently have for COVID-19, Popular Science, March 29, 2021.
This international clinical trial aims to identify treatments that may be beneficial for people hospitalised with suspected or confirmed COVID-19. Here are some results for several drugs.
FasterCures, a center of the Milken Institute, is currently tracking the development of treatments and vaccines for COVID-19 (coronavirus). This tracker contains an aggregation of publicly-available information from validated sources.
Widely prescribed cardiovascular drugs, some recently suspected in high death rates of infected patients, now are being studied for potential protection.
RECOVERY trial finds aspirin does not improve survival for patients hospitalised with COVID-19.
RECOVERY trial finds no benefit from azithromycin in patients hospitalised with COVID-19
Inhaled corticosteroids in virus pandemics: a treatment for COVID-19? - Dan V Nicolau & Mona Bafadhel
RECOVERY trial finds colchicine does not improve survival for patients hospitalised with COVID-19
Among patients hospitalised with COVID-19, high-titre convalescent plasma did not improve survival or other prespecified clinical outcomes - Recovery Trial
Low-cost dexamethasone reduces death by up to one third in hospitalised patients with severe respiratory complications of COVID-19 - Recovery Trial
No clinical benefit from use of hydroxychloroquine in hospitalised patients with COVID-19 - Recovery Trial
The antiparasitic drug was thought to be a potential treatment for COVID-19, but there isn't sufficient evidence to recommend its use, despite widespread support online - Gordon Dent
Vague success claims aside, a handful of others have written about the possible ways melatonin might reduce the severity of a SARS-CoV-2 infection, and there's currently a clinical trial running in the U.S. to examine this possibility. However, “at this time, early SARS-CoV-2 intervention with melatonin is not well supported,” says Cesar Borlongan, a neurologist at the University of South Florida. Much more rigorous research is needed to determine whether the molecule can do more than regulate sleep-wake cycles.
RECOVERY trial finds Regeneron’s monoclonal antibody combination
reduces deaths for hospitalised COVID-19 patients who have not
mounted their own immune response.
Because the disease affects different people in different ways. Anything that works on even part of it, can and will be used to save lives and shorten the duration of the disease, when dosed on the right patients at the right time in the right method.
That is the goal here. Anything that helps that happen is worth celebrating _ Shazbot
Parallels drawn with early data on hydroxychloroquine.
The antiviral drug Remdesivir is the first step in what we project will be better and better drugs coming along to treat COVID-19 - Anthony Fauci
The other thing to emphasize... is that none of these drugs directly alter the pandemic itself. They will save more lives when people get infected, but we really need to try to keep more people from getting infected in the first place, especially now that it’s become more apparent that social distancing and as trivial a thing as public use of face masks can help. We could be mitigating this pandemic with such measures in this country, but in too many regions we don’t seem to be doing that. Eventually, though, what makes this disease go away will be a vaccine.
Tocilizumab reduces deaths in patients hospitalised with COVID-19 - Recovery Trial
No mRNA vaccine has ever been mass-produced to fight a disease — coronavirus would be the first - Matthew Rozsa
A group of researchers and doctors have formed an international alliance aiming to encourage governments to increase recommendations for vitamin D intake to 4,000 IU daily as they believe this would reduce COVID-19 hospitalisations.
Evidence is growing that shows nutritional status plays a part in how Covid-19 would turn out — whether a person recovers or progresses into a more severe condition. For example, many human studies back the anti-Covid-19 effects of vitamin D, including a randomized controlled trial (RCT). Notably, the second most important nutrient next to vitamin D that could fight Covid-19 is perhaps zinc — why and how?
The antiviral reduced infectious virus in Covid-19 patients in a mid-stage study.
“There is a lot that has changed. We’ve made amazing progress,” Dr. Daniel Kuritzkes, the chief of the infectious disease division at Brigham and Women’s Hospital and a professor at Harvard Medical School, told me in a phone interview last week. “Many of us do have the sense that we’ve gotten better at what we’re doing, and we are seeing less mortality, even among older hospitalized patients with Covid-19.”
Many other drugs remain in the we-don't-know bucket. Those include monoclonal antibodies, even though they have been granted emergency authorization to treat people with mild to moderate infections to keep them out of the hospital.
Researchers have been held back by a lack of relevant research, a scattered array of clinical trials and a fragmented U.S. healthcare system.
Researchers have been held back by a lack of relevant research, a scattered array of clinical trials and a fragmented U.S. healthcare system
Most Covid-19 drug treatments that have been included in trials haven’t panned out. A large new study suggests fluvoxamine might be different.
If there is a way to stop COVID-19, it will be by blocking its proteins from hijacking, suppressing, and evading humans’ cellular machinery.
Experts say oral antivirals, long out of reach, could play a critical role in extinguishing the current coronavirus pandemic and preventing others from emerging
More treatments are available for Covid-19 as hospitalizations spike, but some drugs are sitting on the shelves unused.
Strapped hospitals are struggling to set up infusion sites. But states and the feds can help.
There is now concern that some of the drugs we were giving to Covid-19 patients were more than just useless — they might, in fact, have been harmful.
As the third wave of the pandemic surges, a much-hyped COVID-19 treatment that just received a green light from the FDA — monoclonal antibodies — is beset by shortages and doubts over its effectiveness.
These remdesivir, hydroxychloroquine, lopinavir, and interferon regimens had little or no effect on hospitalized patients with Covid-19, as indicated by overall mortality, initiation of ventilation, and duration of hospital stay.
Doctors must optimize treatments for deadly inflammation in Covid-19 patients to save more lives.
The latest on the innovations that will let us go back to normal.
One of the small-molecule drugs that’s getting attention as a possible coronavirus treatment is Ivermectin, which is an interesting story from a couple of different directions. I’ve been getting some inquiries about it, so I thought it was time to have a look.
The treatment combines two antibodies — casirivimab and imdevimab — and administers them together by IV. In a clinical trial of about 800 people, the combination was shown to significantly reduce virus levels within days of treatment.
In its authorization on Saturday, the FDA made clear that the drug is only for the treatment of mild to moderate COVID-19 in people 12 years and older who are at high risk of developing more severe symptoms. It's not for patients who are hospitalized because of COVID-19 or who require oxygen therapy because of the virus.
Many of the current studies have low numbers of participants, weak study designs, and inconsistent (and relatively low) ivermectin dosing regimes, with ivermectin frequently given in combination with other drugs.
... considering the common role of the Janus kinase-signal transducer and activator of transcription (JAK-STAT) pathway in AT1-R expressed on peripheral tissues and cytokine receptors on the surface of immune cells, potential targeting of this pathway using JAK inhibitors (JAKinibs) is suggested as a promising approach in patients with COVID-19 who are admitted to hospitals.
“What we’re having is a populist treatment, instead of an evidence-based treatment,” says García.
The US National Institutes of Health (NIH) has announced that preliminary results from a Phase III clinical trial of Eli Lilly and Company’s investigational monoclonal antibody, LY-CoV555, showed it failed to provide clinical benefit in hospitalised Covid-19 patients.
Germicidal lighting and a tuberculosis vaccine should be a part of the pandemic response.
Hopes for a relatively quick return to normalcy are riding high on promising news about Covid-19 vaccines. Nearly 200 vaccines are in development worldwide. And with six of them already being tested in Phase 3 clinical trials, the possibility exists that a vaccine could be ready by the end of the year
But we need to be realistic: A vaccine is not a silver bullet. Even if one (or more) is proven safe and effective, vaccines are notoriously difficult to make and distribute.
Convalescent plasma has shown enough promise against COVID-19 that hundreds of hospitals around the country have put it to use. While still considered an experimental treatment, patients are receiving convalescent plasma through clinical trials and by way of compassionate use, which the Food and Drug Administration expanded access to earlier this year.
Thousands of people received convalescent plasma as an experimental treatment for Covid. A new study shows that it works — but only when given within a few days of the onset of illness.
If newspaper headlines are to be believed, there is a simple way to protect ourselves from the coronavirus: take a daily vitamin D tablet. Some say the benefits are so great that people should take mega-doses. But the scientific evidence doesn’t back up the claims. What should we believe?
What makes the work done by Chanda and his colleagues noteworthy is the number of drugs they assessed and the speed with which that happened.
First large-scale analysis of patients receiving experimental treatment for coronavirus is expected to lead to more trials to test effectiveness of therapy
Radiation was used experimentally in the early 1900s for lung infections.
A spate of recent media headlines have described blood thinning medications – which include aspirin and warfarin – as a “breakthrough treatment” for COVID-19 that could “save lives”.
It’s early days yet but a growing body of research evidence suggests COVID-19 causes abnormalities in blood clotting, which means blood thinning drugs may have a role to play in treatment.
Here’s what the research says on this question – and how it applies to you.
An up-to-date summary from EMCrit Project.
In just three months, one British research team identified the first life-saving drug of the pandemic (and helped cancel hydroxychloroquine).
How optimistic should we be about the impact of artificial intelligence in a pandemic?
If you've recovered from the coronavirus, your plasma might be useful to other people.
Emerging clinical trial data suggest that individual immunomodulatory drugs can dampen the hyperactive immune system in severe COVID-19, but polytherapy is the way forward.
Researchers are looking to find a more potent coronavirus-fighting cocktail.
Even moderately effective therapies or combinations could dramatically reduce the crushing demand on hospitals and intensive care units, changing the nature of the risk the new pathogen represents to populations and healthcare systems. New drugs, together with new diagnostics, antibody tests, patient- and contact-tracing technologies, disease surveillance and other early-warning tools, mean the anticipated next 'wave' of the global pandemic does not have to be nearly as bad as the first.
More than 70 vaccine candidates are also in development around the world, with at least five in preliminary testing in people. Here are some of the drugs, vaccines and other therapies in development:
Scientists are following several paths in the battle with Covid-19 as they seek to help treat patients in the short term and protect the population in the future.
The drug failed as a treatment for hepatitis and Ebola. With federal funding, scientists trained it on the coronavirus.
An abundance of scientific data shows that the drug isn’t an effective COVID-19 treatment.
The positive steroid findings — the result of a pooled look at data known as a meta-analysis — confirm a similar survival benefit reported in June from a single, large study. Corticosteroids are the first, and so far only, therapy shown to improve the odds of survival for critically ill patients with Covid-19.
As western countries pontificated against repurposing drugs, proactive Indian doctors chartered their own course -- finding what works and healing people, with amazing results. It’s commendable.
Read more at: https://www.deccanherald.com/opinion/i-m-glad-to-be-living-in-india-at-this-time-926699.html
Evidence suggests that zinc could protect against Covid-19 — how?
How the President of the United States is treated for COVID-19 will likely be very different from how the 7 million-plus other Americans who have contracted the disease were taken care of, at least in some ways. To start, before Trump was hospitalized, his physician Sean Conley revealed that the President received an experimental drug duo from Regeneron of so-called monoclonal antibodies.
More than a dozen drug firms in Massachusetts are urgently searching for a medicine to treat COVID-19, but the most potent therapy may not end up being a single medication. Instead, medical experts say, the most effective way to battle the disease will likely be a combination of drugs taken together.
Insilico Medicine, a startup based in Rockville, Md., says it has used artificial intelligence to rapidly identify molecules that could form the basis of an effective treatment against the coronavirus at the heart of the current outbreak. It took Insilico's A.I.-based system four days to identify thousands of new molecules that could be turned into potential medicines against the virus.
A new study suggests a treatment Trump touted is harmful. Let’s take a closer look at the data.
We are in desperate need of a safe and effective treatment for COVID-19. Scientists around the world are racing against time to find a cure. Here’s what we know so far about emerging treatments for coronavirus,
So-called monoclonal antibodies could help treat patients, protect at-risk groups, and also improve vaccines.
A network of scientists is chasing the pandemic’s holy grail: an antibody that protects against not just the virus, but also related pathogens that may threaten humans.
Early trials show signaling cells eliminate the virus, calm the immune response and repair tissue damage.
Antibody drugs like the one the president took may be a bridge to a vaccine.
Scientists have no shortage of contenders to fight the new coronavirus. But to find the winners, they’re trying new approaches to testing.
Many options are being explored to treat COVID-19. These include new drugs specifically designed to target SARS-CoV-2, as well as “repurposed” drugs - that is, existing drugs designed to treat a different disease. By far the oldest treatment being tested, though, is convalescent plasma.
The frantic pace of the coronavirus has led us to repeat mistakes we’ve made before.
Antivirals and blood therapy sound promising, but how do they work, and when will we know if they truly treat COVID-19?
In the search for treatments for COVID-19, many researchers are focusing their attention on a specific protein that allows the virus to infect human cells. Called the angiotensin-converting enzyme 2, or ACE2 “receptor,” the protein provides the entry point for the coronavirus to hook into and infect a wide range of human cells. Might this be central in how to treat this disease?
Doctors should follow the evidence for promising therapies. Instead they demand certainty.
Thanks to the Recovery trial, based at Oxford University, we’re finding out more all the time about which therapies are useful. So, while the below won’t be the definitive answer on how to treat COVID-19... this is what we know so far about what works.
More treatments are available for Covid-19 as hospitalizations spike, but some drugs are sitting on the shelves unused.
We’ve come a long way since the beginning of the pandemic.
FDA has created a special emergency program for possible therapies, the Coronavirus Treatment Acceleration Program (CTAP). It uses every available method to move new treatments to patients as quickly as possible, while at the same time finding out whether they are helpful or harmful.
Healthy people can help in the fight against the pandemic by volunteering for a clinical trial to find safe and effective new vaccines.
We're on a mission to find an existing drug or drug combination that, when given early, reduces hospitalization and fatality rates by 75% or more.
This tracker will be updated weekly with the latest in developments for treatment candidates who have advanced to at least Phase 1 study.
This article was published in collaboration with MDCalc.
The MATH+ Hospital Treatment Protocol for COVID-19 is designed for hospitalized patients, to be initiated as soon as possible after they develop respiratory difficulty and require oxygen supplementation.
The Front Line COVID-19 Critical Care Alliance has now developed a preventive and early outpatient combination treatment protocol for COVID-19 called I-MASK+. The “I” in this protocol for ivermectin, a well-known anti-parasite drug.