10 Drugs That Show Promise in Treating COVID-19
March 27, 2020
DISCLAIMER: I’m not a doctor, nor do I play one on TV. I’m a layman who was intrigued by articles on drugs that are being considered as treatment options for hospitalized COVID-19 patients. I pulled together information from over 20 articles and came up with the summary piece below.
It’s a summary of other articles. Nothing here should be considered medical advice. Do not use any drug or therapy for any illness unless directed by a qualified medical professional. (And that’s not me.)
Many countries, including the U.S., are attempting to slow the spread of coronavirus by encouraging or even mandating that citizens stay home and avoid interacting with others.
But what happens if, in spite of your best efforts, you become infected by the virus?
In South Korea, officials determined that about 90% of the people who are infected do not need to be hospitalized but can achieve a full recovery at home. Common at-home treatments, which are intended to relieve symptoms, may include pain relievers (ibuprofen or acetaminophen), cough syrup or medication, rest, and increased fluid intake.
In about 10% of cases, however, patients need medical treatment at a fully-equipped hospital. Because there are no targeted therapeutics or vaccines for the virus, the role of doctors and nurses, even in ICUs, is to administer drugs and oxygen that keep patients alive long enough for their bodies to fight the infection. If a patient contracts pneumonia, then his or her body must also fight to repair lung damage from that disease.
Treatment or Vaccine for COVID-19: How Soon?
On February 28, Itai Bloch, Head of Computational Chemistry and Rational Antigen Prediction Team at the MIGAL Galilee Research Institute in northern Israel, announced on Facebook that his team “could be very close to creating a vaccine to fight the coronavirus”. In an interview two weeks later, Bloch said that MIGAL’s development efforts are leveraging four years of research to develop a vaccine against an avian coronavirus, the Infectious Bronchitis Virus (IBV), for the poultry industry. The effort to adapt that vaccine to the human coronavirus began after Chinese scientists sequenced the genome for the human virus. When available, the vaccine developed by MIGAL will be taken orally.
So, when will it be available? A first version could be ready in early April, but it still must go through internal testing and clinical trials. The former will take about three months; the latter could take longer.
Like researchers at MIGAL, scientists around the world are leveraging research done on other coronaviruses, such as those that caused the severe acute respiratory syndrome (SARS) outbreak in 2003 and the Middle East respiratory syndrome (MERS) outbreak in 2012. Because all coronaviruses are similar genetically, using existing research may accelerate the development of vaccines and drug therapies for COVID-19. Even so, the anticipated time frame to bring COVID-19 medicines to market is at least a year.
Repurposing Other Drugs for Treating COVID-19 Patients
With thousands of COVID-19 patients in hospitals now, healthcare professionals worldwide are hopeful that drugs approved for treating other diseases may prove effective at combatting the respiratory illnesses caused by COVID-19. Of 10 drugs being considered for treating COVID-19 patients, The Jerusalem Post reports that Israel’s Health Ministry has “fast-tracked approval” for eight of them, in hopes that they will shorten recovery times and reduce complications. Other countries have approved the use of some or all of the 10 drugs for treating COVID-19 patients.
Let’s take a quick look at each of the 10.
1. Chloroquine
Used to treat patients with malaria for nearly a century, chloroquine is a synthetic version of quinine, which people have extracted from the bark of cinchona trees for 400 years. Chloroquine combats the effects of a virus by making it more difficult for the virus to enter cells through compartments in a cell called vacuoles. Some researchers have suggested that the drug’s ability to give the body’s immune system more time to respond to COVID-19 may prevent a cytokine storm, a potentially deadly overreaction to the disease that can result in organ failure.
Preclinical research has shown that chloroquine is effective against other viral infections such as SARS, MERS, and HIV. Clinical trials of chloroquine’s efficacy against coronavirus are underway in China, and early results show that the drug slows the virus’s rate of replication.
Chloroquine is safe in humans. It’s inexpensive. And it is championed by President Trump, who has asked the Food and Drug Administration (FDA) to examine its feasibility as a COVID-19 treatment.
2. Hydroxychloroquine
Hydroxychloroquine is a metabolite of chloroquine that is FDA-approved for the treatment of malaria and two autoimmune diseases: lupus and rheumatoid arthritis. Because it appears to disrupt communications between cells in the immune system, hydroxychloroquine may mitigate cytokine storms. Clinical trials of the drug to treat COVID-19 patients are underway in China, and the University of Minnesota has launched a 90-day trial of its own.
President Trump has asked the FDA to investigate not just chloroquine but hydroxychloroquine, too. On Saturday, he tweeted an endorsement of a preliminary report from France which concluded that “hydroxychloroquine treatment is significantly associated with viral load reduction/disappearance in COVID-19 patients and its effect is reinforced” when the antibiotic azithromycin is added. Israeli pharmaceutical giant Teva has announced that it will donate more than six million doses of hydroxychloroquine sulfate tablets through wholesalers to hospitals across the United States, starting March 31. “We are committed to helping to supply as many tablets as possible, as demand for this treatment accelerates, at no cost,” said Teva executive Brendan O’Grady.
3. Favipiravir
4. Baloxavir Marboxil
Favipiravir and baloxavir marboxil are antiviral medications used to treat those who are seriously ill due to complications from the flu. Accidentally discovered in 2014 at a subsidiary of Fujifilm in Japan, favipiravir inhibits the RNA polymerase of the influenza virus and appears to be effective against all subtypes of the flu. Baloxavir marboxil inhibits a protein called endonuclease that is needed for flu to duplicate.
Of the two, favipiravir shows more promise in combatting COVID-19. Zhang Xinmin, an official at China’s science and technology ministry said favipiravir had produced encouraging outcomes in clinical trials involving 340 COVID-19 patients. “It has a high degree of safety and is clearly effective in treatment,” Zhang told reporters on Tuesday.
Doctors in Japan are using the drug in clinical studies on patients with mild to moderate symptoms, hoping it will prevent the virus from multiplying in patients. A Japanese health ministry source said that the drug “doesn’t seem to work that well when the virus has already multiplied.” Unless there are delays in the results of clinical research, the drug should be approved in Japan for use with COVID-19 in May.
5. Remdesivir
While it failed in its mission to fight Ebola, remdesivir has shown to have some effect against both MERS and SARS, possibly because it blocks RNA replication during the reproductive cycle of a virus. A few clinical trials for treating COVID-19 are underway, and preliminary results may be available in April.
There are two possible success stories already. In the U.S., a COVID-19 patient was given remdesivir after his condition took a turn for the worse, and he began to recover the next day, although no one can verify that the drug was responsible for his improvement. In Israel, a bus driver who was hospitalized with COVID-19 in the Puria Medical Center in Tiberias saw a dramatic improvement after taking remdesivir, and he subsequently was taken off a respirator.
6. Losartan
The hypertension drug losartan reduces blood pressure by preventing a particular hormone from binding to receptors on blood vessels, allowing them to stay relaxed. Scientists have hypothesized that losartan might help patients with COVID-19 because, by blocking that same hormone, it may prevent the virus from entering cells. The University of Minnesota plans to conduct clinical trials.
7. Hyperimmune Globulin
8. Interferon Alpha-2b
Two candidates may help the immune system respond more effectively to COVID-19.
Hyperimmune globulin is a plasma-derived vaccine shown to be effective in the treatment of severe acute viral respiratory infections. Research will indicate if the vaccine’s antibodies can hone in coronavirus in the body and signal white blood cells to attack it.
Interferons are proteins, secreted in response to infections, that activate components of the immune system to attack and eliminate the viruses. Interferon Alpha-2b – sometimes called Cuban Interferon because it was developed by Cuba’s biotech industry – has been used to treat viral diseases such as Hepatitis B and C, shingles, HIV, and dengue.
There are reports that Interferon Alpha-2b has had some success in helping Cuban patients battle the complications of COVID-19. Cuba has supplied the drug to China and Italy, and the government of Ireland is considering working with Cuban health authorities to acquire the medicine for use in Ireland.
9. Lopinavir/Ritonavir
10. Darunavir/Cobicistat
The final two candidates are drug combinations – a drug and a booster – that have been used to fight HIV. In each combination, the drug blocks enzymes that HIV uses to duplicate, and the booster increases the drug’s concentration in cells.
Several clinical trials are underway to see if either drug combination can disrupt the COVID-19 life cycle in a similar way. A study published in the New England Journal of Medicine reported no benefit to the first combination, lopinavir/ritonavir, for patients with severe COVID-19, and other studies have yielded similar findings.
Picking Winners
Five of the drugs – chloroquine, hydroxychloroquine, favipiravir, remdesivir, and Interferon Alpha-2b – are generating the most excitement, but any or all of the 10 may prove beneficial in battling COVID-19, the disease caused by coronavirus.
Let’s pray that we have more than one winner from among the 10 candidates.
And soon.