While a vaccine is likely more than a year away, a recent presidential Covid-19 Task Force briefing led to a cascade of media chatter about viable drug treatments for the illness – and some individuals have even taken to self-administering medications, with deadly results.
There are some current trials happening, they go beyond antimalarials, which in fact, are not indicated from a broad range of patients.
Chloroquine: This drug was developed in the 1940’s to fight the infection that leads to malaria, and for years was the go-to treatment. A 2005 study by Len Horovitz, a pulmonary specialist at Lennox Hill Hospital in New York, found that chloroquine was also effective in preventing the spread of SARS Cov-1, the virus behind the so-named epidemic of the early 2000’s. In light of the current pandemic, it is now being evaluated as a covid-19 treatment. It seems to be working, in vitro. The drug interferes with two different pathways the virus uses to replicate itself.
A magic bullet, chloroquine is not. It is an aggressive drug, with dangerous side effects, and is not suitable for a wide range of patients.
Hydroxychloroquine: This is a less toxic cousin of the above. It works in largely the same way, but with fewer side effects. Both it and chloroquine are available in the U.S. for off-label use, meaning that a medical professional can prescribe it in a way not specified by the FDA. Though this practice is legal, it can lead to dosage errors. It has also caused the hoarding of available stocks of the drugs, a practice which both hampers research, and deprives patients who are already using it for non-covid ailments, such as lupus.
It should be noted that neither of these old-school malaria drugs are currently very effective at treating the malaria of today. This is important from a public health perspective because chloroquine’s increased production can lead to its resurgence in the drug markets of developing countries. If it is sold at a price point that undercuts effective malaria medications, it will likely sell well, to the detriment of populations trying to keep malaria in check. Kanyidaily.
Trials are underway for these drugs in China, South Korea and France, and a large FDA trial is being organized here. Some U.S. hospitals are administering the drug already. See the story in Live Science. Notably, these medications are generally considered contraindicated for patients with psoriasis, heart arrhythmia, or impaired kidneys or liver. Interactions with other drugs have also proved to be problematic.
Recently, there have been instances of people self-administering these medications, rather than seeking advice from a physician about appropriateness and dosage. Predictably, this has led to some deaths.
Actemra: This is among a host of drugs that manage the body’s inflammatory response. It is currently used to treat rheumatoid arthritis, a condition in which a person’s own immune cells attack healthy tissue. A similar situation can occur in covid-19. If a rapid viral infection of the lungs triggers a flood of immune cells, something called a cytokine storm can occur. Very simply, this means that the immune system spirals out of control, and can attack other, unaffected tissue in its zeal, leading to multiple-organ failure. An FDA trial of Actemra on 330 hospitalized covid-19 patients is slated to begin in April. Oregon Live.
Remdesivir: A relative of drugs currently used to treat HIV, remdesivir targets an enzyme that SARS Cov-2 uses to replicate. Though still in its experimental stages, and a potentially promising treatment, it has been widely prescribed under the FDA’s “compassionate use” program. Though some patients have gotten better, the lack of controls and adequate testing has not helped legitimate research. There are five such large clinical trials running, with more planned.
The untested use of remdesivir has grown so popular that the drug’s manufacturer, Gilead Sciences, recently had to pause “compassionate use” access so that it will be able to produce enough for medical testing. Stat.
Serum: As previously reported by The Advocate, Dr. Robert Kruse of Johns Hopkins is working on a treatment that could be implemented in weeks instead of months, and that’s because it hearkens back to days of old. Blood is taken from healthy patients who have had the disease and recovered, and injected into a sick patient. This well-established practice, called passive antibody therapy, has been used widely in many historical disease outbreaks. You don’t need to get FDA approval to do serum therapy, but there are drawbacks, one of which is that it takes one healthy human to treat a sick one, so it is a labor-intensive process.
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