Even with three highly effective vaccines abundantly available across the country, the delta variant of SARS-CoV-2 continues to cause large numbers of new infections, especially in states where vaccination rates remain low. As schools and businesses reopen and the holiday season approaches, another surge in infections could be imminent.

There is some good news, however. Numerous drugs, including young and reused drugs, are available. For hospitalized COVID-19 patients, these new treatments carried along with supportive treatment advances – such as today.

As an infectious disease doctor and scientist, I’ve been working on finding new treatments for patients since the beginning of the pandemic. Here’s a look at some of them, with one caveat: while these drugs could help many patients, they don’t replace the vaccine, which is still your best defense against the virus.

The right drug at the right time

COVID-19 has two main phases.

In the early stages of the disease, the SARS-CoV-2 virus multiplies in the body; the virus itself causes disease. The immune system clears the virus within the first 10 days, but this process can cause collateral damage.

A second phase of the disease can set in, which occurs when the patient has an impaired inflammatory response.

Because of this, it is important to use the right medication at the right time. For example, an antiviral drug can help a patient with early and mild symptoms. But for someone who has a ventilator after weeks in the hospital, it’s not useful.

Conversely, patients in the intensive care unit could benefit from an anti-inflammatory drug that can prevent damage to organs such as the kidney and lungs; this damage is called sepsis. But the same drug used during the viral phase of the disease could affect a patient’s ability to fight off COVID-19.

Antiviral drugs

Three monoclonal antibody antiviral drugs approved for use in the United States can prevent the virus from infecting new cells by targeting the SARS-CoV2 spike protein. For outpatients with early-stage COVID-19, these drugs reduce the risk of hospitalization and death. One of them – REGEN-COV – can prevent high-risk patients from getting sick.

These antiviral drugs could also help hospitalized patients whose bodies are unable to produce antibodies on their own, either due to immunosuppressive drugs or a weakened immune system from another disease.

A study, which has not yet been peer-reviewed, shows that hospital patients without natural antiviral antibodies had a lower risk of death after receiving one of these drugs. But this treatment is usually not available except through a compassionate use program. In order to obtain the drug for a patient, a doctor must seek approval from both the drug manufacturer and the FDA.

Another problem: the large-scale administration of these antiviral drugs is a challenge. Health care workers must hand them in shortly after symptoms start. The infusion or injection must be done in a monitored environment. Patients may have difficulty accessing treatment quickly.

Mixed signals on remdesivir

One of these antiviral drugs, remdesivir, has shown activity in the laboratory against a wide range of viruses, including coronaviruses such as SARS-CoV-2. It works by preventing the virus from making more copies of its genetic material.

Two clinical studies conducted at the start of the pandemic show that remdesivir shortens recovery time for hospitalized COVID-19 patients. A recent study found that it reduced the risk of death. But two other studies, one mainly in low- and middle-income countries by the World Health Organization and another in Western Europe, showed no clear benefit of remdesivir in hospitalized patients.

The medical community has interpreted the conflicting data differently. Remdesivir Received FDA Approval for Treatment of COVID-19; Both the Infectious Diseases Society of America and the National Institutes of Health recommend the drug for hospital patients. But the World Health Organization doesn’t, at least outside of a clinical trial.

Anti-inflammatory drugs

Steroids like dexamethasone can largely suppress the immune system and in turn reduce inflammation. According to a February 2021 study published in the New England Journal of Medicine, treatment with dexamethasone lowered the risk of death in hospitalized patients. The benefit was greatest for patients who needed the most respiratory support. But in the same study, dexamethasone had no benefit and could even be harmful to patients who do not need oxygen therapy.

IL-6 inhibitors

Steroids are a blunt tool for immunosuppression; other anti-inflammatory drugs work more specifically on the immune system. Seriously ill COVID-19 patients with inflammation may have elevated levels of the IL-6 cytokine, a molecule the immune system uses to coordinate a response. In these patients, both tocilizumab and sarilumab – two drugs that block the response of cells to IL-6 – when combined with dexamethasone can reduce inflammation and lower mortality.

JAK inhibitors

A class of drugs called JAK inhibitors – JAK stands for a family of enzymes called Janus kinases – can also change the body’s response to inflammation. They are used in some autoimmune diseases, including rheumatoid arthritis, and block inflammation caused by IL-6.

The addition of baricitinib, a JAK inhibitor, to remdesivir helped hospital patients recover faster than using remdesivir alone. Baricitinib also reduced mortality in hospitalized patients treated with dexamethasone. And in the sickest COVID-19 patients, it helped reduce inflammation.

Of the drugs discussed, only the antiviral monoclonal antibodies are currently available to doctors for prescription for patients outside the hospital. There remains a clear need for other drugs to help patients with early symptoms who are not hospitalized. Older drugs that can be used to treat these patients include inhaled corticosteroids and fluvoxamine, an antidepressant.

A dangerous trend

Regarding the now controversial drug Ivermectin: Preliminary results of a randomized, placebo-controlled study showed no benefit for COVID-19 treatment. Two more studies, also randomized and placebo-controlled, are ongoing.

As far as we know, ivermectin should not be used to treat COVID-19 patients for the time being. If used incorrectly, this drug can cause serious harm. Ivermectin is approved for the treatment of parasitic worms and head lice; but its off-label use to treat COVID-19 has resulted in overdoses and hospitalizations. Ivermectin’s toxicity can cause nausea, vomiting, diarrhea, low blood pressure, confusion, seizures, and death.

The urgent search for COVID-19 treatments has highlighted the need for high quality science. Early on, limited studies led some to believe that hydroxychloroquine would be useful for COVID-19. However, over time, more rigorous research showed that the drug had no value for COVID-19 treatment.

Randomized, placebo-controlled studies – in which patients are randomly given either the test drug or a placebo – are the gold standard of medicine. They help doctors avoid the many sources of bias that can lead us to conclude that a drug is helpful is when it really isn’t. In the future, it is this type of research – and evidence – that is essential to discovering new and effective COVID-19 treatments.

Patrick Jackson, Assistant Professor of Infectious Diseases, University of Virginia

This article was republished by The Conversation under a Creative Commons license. Read the original article.

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