COVID-19 Treatments: The Latest

[J.Adderton, BSN, MSN]

Since the first U.S. case of COVID-19 was diagnosed, researchers have worked to develop safe and effective treatments. While we know much more about the virus since the initial outbreak, there’s still no specific antiviral treatment for COVID-19. One reason is that antivirals have a complex job, and to be effective they must be able to:

• Target a very specific part of the virus’s life cycle
• Kill the virus, but not harm the human cells it occupies

Viruses reproduce quickly and are able to change their genetic make-up. Because the virus mutates, there’s potential for COVID-19 to adapt and build resistance when drugs and vaccinations are developed.

Until a COVID-19 specific treatment is developed, let’s look at other therapies that are currently being investigated.

Remdesivir

Researchers are working to determine if antivirals, used to treat other viruses, might be effective against COVID-19. On May 1, 2020, The U.S. Food and Drug Administration approved remsdesivir for doctor’s emergency use to treat severe cases of COVID-19. Remdesivir isn’t new and was originally developed to treat Hepatitis C and the respiratory virus, RSV. The drug was also laboratory tested as a potential treatment for Ebola and two other coronaviruses, SARS and MERS.

On August 10th, Gilead Sciences Inc. filed a new FDA drug application for the use of remdesivir in the treatment of COVID-19. The application was based on Gilead’s research on hospitalized COVID-19 patients treated with the antiviral. Data from two clinical studies showed:

• patients receiving remdesivir ecovered faster when compared with a placebo
• both studies found remdesivir to be generally well-tolerated with no new safety concerns
• remdesivir is not effective in the prevention of COVID-19

Hydroxychloroquine and Azithromycin

Early in the pandemic, reports from China and France were optimistic that hydroxychloroquine and chloroquine improved symptoms of COVID-19. The countries also reported positive patient outcomes when hydroxychloroquine and azithromycin were used together. All three medications are inexpensive and have been around for a long time. Let’s look at how these medications are traditionally used:

Hydroxychloroquine and Chloroquine

• Treatment of malaria and several inflammatory diseases (I.e lupus, rheumatoid arthritis)

Research has shown the drugs to kill the virus in a laboratory dish by:

• Makes it difficult for the virus from entering cells and multiplying.
• If the virus does enter a cell, the drugs destroy it before it can multiply.

Azithromycin

• Common antibiotic used to treat respiratory conditions (I.e. strep throat, bacterial pneumonia)

Azithromycin has never been used specifically to treat viral infections. However, the drug does reduce inflammation caused by the coronavirus and counters an overactive immune response.

In Combination

More recent studies have suggested the use of hydroxychloroquine or chloroquine, with or without azithromycin, doesn’t benefit COVID-19 patients and may actually increase the risk of fatal arrhythmias.

The Verdict

Currently, it’s not recommended for chloroquine or hydroxychloroquine to be used alone or with azithromycin to treat COVID-19, unless it is prescribed as part of a clinical trial during hospitalization. Research and clinical trials are ongoing to determine if these drugs are effective COVID-19 treatments.

Convalescent Plasma

Convalescent plasma has been used to treat various illnesses for over a century. People who’ve recovered from COVID-19 have antibodies in their system that help fight the virus. The treatment takes plasma from those who’ve recovered from COVID-19 and it’s transfused to someone seriously ill with the virus. The donor’s antibodies help fight the illness and possibly makes the symptoms of COVID-19 less severe. On March 24th, the FDA began allowing convalescent plasma therapy to be used experimentally in patients with severe or immediately life-threatening coronavirus infections.

Dexamethasone

A recent British study, the RECOVERY trial, reported dexamethasone reduced death rates by a third in hospitalized patients with severe COVID-19. The Infectious Diseases Society of America (IDSA) announced dexamethasone will be incorporated into COVID-19 treatment guidelines. It is recommended for hospitalized patients with severe COVID-19 and requiring respiratory assistance.

Want to Know More?

Check out the FDA's daily press releases to get the latest information on COVID-19.

What COVID-19 treatments are you seeing used in your practice?

References

Harvard Health- Treatments for COVID-19

Drug Treatment for COVID-19: A Quick Summary for PCPs

Low cost dexamethasone reduces death by up to one third in hospitalized patients with severe respiratory complications of COVID-19

FDA Recommendations: Investigational COVID-19 Convalescent Plasma

FDA Issues Emergency Use Authorization for Potential COVID-19 Treatment

[sirI, MSN, APRN, NP]

Thank you for the Article, @J.Adderton.

After the recall of all ranitidine (Zantac), I had to switch histamine H2 antagonists and chose famotidine (Pepcid). I've been reading reports indicating that the latter improved clinical outcomes in COVID-19 patients. I'll have to read up on exactly what that involved.

[JVBT, ASN]

The most recent episode of TWIV (This Week in Virology) features a knowledgeable doc / pediatrician (Daniel Griffin) detailing some interesting facets of current practice. This doctor details some behind the scenes "doctor vs doctor" conflicts in the treatment (and RCTs) of Covid.

He says that there exist at some hospitals committees, which enforce order sets for treatment of Covid. This is a significant change in how bedside decisions are made (he says). These committees ("I could never find out who exactly is on the committee when I would ask") have a lot of power, which may be skewing the data, and hindering our understanding of just what is working. Take dexamethasone. Often such committees come in after the fact and discontinue the use of it. So whether the patient got better because of the dex or in spite of early dex that was then discontinued (ie, 'saved from dex') is hard to know - though he does seem to imply that dexamethasone really does work.

Here we are in August, and what have we got? he asks. We understand the clinical course, we are implementing some good social measures, we have Remdesivir and steroids which are cheap, though we're still learning about dosing. And anti-coagulation, but also working on dosing. But we still don't have randomized trials. And it's hard to know without cooperation and communication with research. So says Dr Griffin.

I thought it was interesting.

TWIV episode 656.

[J.Adderton, BSN, MSN]

On 8/23/2020 at 2:00 PM, sirI said:

Thank you for the Article, @J.Adderton.

After the recall of all ranitidine (Zantac), I had to switch histamine H2 antagonists and chose famotidine (Pepcid). I've been reading reports indicating that the latter improved clinical outcomes in COVID-19 patients. I'll have to read up on exactly what that involved.

Thanks for sharing, a co-worker recently made the same switch.  I need to pull together additional research and write 2nd follow-up article.  Learning something new about treatments everyday.

 

[J.Adderton, BSN, MSN]

On 8/24/2020 at 9:56 PM, JVBT said:

The lack of research does muddy the waters around COVID.  Thanks for sharing this source for information.  Really great COVID topics and "latest" news.   Here is the link for other readers, definitely worth checking out:  https://www.microbe.tv/twiv/, 

On 8/24/2020 at 9:56 PM, JVBT said:

But we still don't have randomized trials. And it's hard to know without cooperation and communication with research. So says Dr Griffin.

I thought it was interesting.

TWIV episode 656.

But we still don't have randomized trials. And it's hard to know without cooperation and communication with research. So says Dr Griffin.

I thought it was interesting.

TWIV episode 656.