Which medications and treatments have been shown to work and which have not for COVID-19?

I am a doctor and scientist at the University of Virginia. I care about patients and do research to find better ways to diagnose and treat infectious diseases, including COVID-19. I would like to share what is known about the treatments that work and those that have not worked in fighting this new coronavirus infection.

Keep in mind that this field of medicine is rapidly evolving as we better understand how the SARS-CoV-2 virus works. So what I’m writing today could change in a matter of days or weeks.

Below, you can find the treatments that have been tried and we know better.

Hydroxychloroquine or chloroquine: no evidence that they work

There are three randomized controlled trials on hydroxychloroquine, but none of them have been able to prove or disprove a beneficial or detrimental effect on the clinical course of COVID-19 or shedding of the virus. Given the current lack of evidence, these drugs, which are commonly used to treat arthritis, should only be administered in a controlled clinical trial setting.

Lopinavir / ritonavir: not helpful

The drug lopinavir is an inhibitor of an enzyme called HIV protease that is involved in the production of viral particles. The protease inhibitors for HIV were revolutionary and improved our current ability to effectively treat this virus. Lopinavir can also inhibit enzymes that perform functions similar to HIV protease in coronavirus SARS y MERS. Ritonavir increases the level of lopinavir in the blood, so a randomized controlled clinical trial for COVID-19 tested the combination of lopinavir and ritonavir.

Unfortunately, there was no impact on throat virus levels or duration of virus shedding, nor did it change the clinical course or survival of the patients. So, there is no room for lopinavir / ritonavir in the treatment of COVID-19.

Steroids: yes, for almost all COVID-19 patients

When a synthetic steroid hormone called dexamethasone was given to COVID-19 patients, the drug decreased the mortality at 28 days by 17% and accelerated hospital discharge.

This work was carried out in a randomized controlled clinical trial in more than 6,000 patients and, although it was not repeated in another study and has not yet been peer reviewed, there is no doubt that it provides sufficient evidence to recommend its use.

Tocilizumab: too early to judge

Tocilizumab is a antibody It blocks a protein, called the IL-6 receptor, from binding to IL-6 and causing inflammation. IL-6 levels are higher in many COVID-19 patients, and the immune system in general appears to be overactive in those with more severe conditions. This has led many doctors to think that inhibiting the IL-6 receptor could protect patients from developing serious disease.

Currently, the United States government health agency has approved tocilizumab for the treatment of rheumatoid arthritis and other collagen vascular diseases and for “cytokine storm“, A harmful overreaction of the immune system that can be caused by certain types of cancer therapy and COVID-19.

A retrospective observational study found that COVID-19 patients treated with tocilizumab had a lower risk of needing mechanical ventilation and dying. But we do not have a randomized controlled clinical trial, so there is no way to determine whether this apparent improvement was due to tocilizumab or the imprecise nature of the retrospective studies.

Convalescent plasma: too early to judge

Convalescent plasma, the fluid derived from the blood after removing the white and red blood cells, contains antibodies from previous infections that the plasma donor had. This plasma has been used to prevent infectious diseases such as pneumonia, tetanus, diphtheria, mumps, and chickenpox for more than a century. It is believed that it benefits patients because antibodies in the plasma of survivors bind and inactivate pathogens or their toxins in patients. Convalescent plasma has already been used in thousands of COVID-19 patients.

However, the only randomized clinical trial has been small and included only 103 patients who received convalescent plasma 14 days after becoming ill. There were no differences in time to clinical improvement or mortality between those who received the treatment and those who did not. The encouraging news was that there was a significant decrease in the levels of virus detected by PCR.

Therefore, it is too early to know if it will be beneficial and there is a need for controlled clinical trials.

Remdesivir: yes, it reduces hospital stay

He remdesivir is a drug that inhibits the coronavirus enzyme that makes copies of the viral genome of RNA. It works by causing a premature stop or termination of the copy and ultimately blocking the replication of the virus.

Remdesivir treatment, especially for patients who required supplemental oxygen before using mechanical ventilation, reduced mortality and shortened recovery time average 15 to 11 days.

ACE Inhibitors and ARBs: Keep Taking Them

There was concern that drugs called ACE inhibitors or angiotensin receptor blockers (ARBs), which are used to treat high blood pressure and heart failure, will increase levels of the proteins ACE2, the receptor of SARS-CoV-2 on the surface of the body’s cells. According to doctors, this would increase the entry points for the virus to infect cells and thus exacerbate new coronavirus infections.

However, there is no evidence that this occurs. The American Heart Association, the American Heart Failure Society, and the American College of Cardiology recommend that patients continue to take these medications during the pandemic as they are beneficial in the treatment of high blood pressure and heart failure.

We have made amazing progress in treating COVID-19. Two therapies, steroids and remdesivir, have already been shown to help. Those who benefit from these treatments should thank the patients who volunteered to participate in controlled clinical trials and the doctors and pharmaceutical companies who conduct them.

This article was translated by Yahoo!.

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