Five months have passed since we realized that Sars-CoV-2 had arrived in Italy with the case of “patient one”. Suddenly a completely new disease appeared before the eyes of doctors. A mysterious disease without cure, which has killed almost 35,000 people in our country alone.
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The March massacre seems distant. What has changed since then?
«Today Covid-19 (coronavirus disease) is no longer a faceless enemy and, above all, we have weapons to defend ourselves – he says Filippo Drago, full professor of Pharmacology and director of the Operational Unit of Clinical Pharmacology at the Policlinico of Catania -. They are “repositioned” drugs, that is, designed to treat other pathologies. Like remdesivir, antiviral born as anti-Ebola and never on the market, because it is still being tested: on June 25, the European Medicines Agency (Ema) authorized it in the treatment of coronavirus pneumonia with the need for mechanical support for breathing. Remdesivir it is the first drug recognized as effective against Covid by the entire scientific community and regulatory agencies. It will probably be approved for hospital use only, so it cannot be used for patients who are isolated at home with non-serious forms. But first remdesivir will have to undergo some clinical tests required by Ema ».
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What other drugs have proven effective?
«We have recently talked about dexamethasone, a corticosteroid capable of blocking the molecules that trigger inflammation. It is a class A medicine – underlines Drago, who is also a member of the Covid-19 Crisis Unit of the Italian Society of Pharmacology -, therefore it can be prescribed by the family doctor. So far it has been administered to a few patients, but it has been shown to work. It is a candidate to be a suitable therapy also for domiciled patients. With a warning: it should not be used in the early stages of the infection, because it can worsen its course. There is a precise moment in which it is useful, that is when from the mild symptoms one passes to the first signs of respiratory failure ».
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How will patients be treated if the virus hits back hard?
“Doctors will have at their disposal, in addition to remdesivir and dexamethasone, enoxaparin, a fundamental drug in counteracting the risk of thromboembolism closely related to Sars-CoV-2 infection, which in many cases has been the cause of death of the sick – says Filippo Drago -. Furthermore, the clinical study on tocilizumab, a biological drug with anti-inflammatory effect, continues. If the results are positive, we can also resort to this therapeutic option “.
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In Italy, 35 trials have been launched, aimed at testing other medicines in addition to those mentioned so far. Are there any promising ones?
“Unfortunately no, many therapies have been tried since the beginning of the epidemic, even a little blindly, but many have not proved effective – explains the pharmacologist -. For a possible second wave, which I don’t think will occur with the same proportions as the first, we will have remdesivir, dexamethasone, enoxaparin and probably tocilizumab available. But the search for possible treatments must go on, we are only halfway there. A separate case is that of chloroquine (and the most famous hydroxychloroquine): regardless of the efficacy, however modest, against infection, the World Health Organization and the national regulatory agencies have decided to block the use of these drugs for the high risk of toxic effects on the heart “.
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July 13, 2020 (change July 13, 2020 | 11:11 pm)
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