When the coronavirus epidemic started to spread we wrote about investing in pharmaceuticals and the coronavirus. We noted that a vaccine is a long way off and that a better short term investment strategy would be invest in companies that make hand sanitizers, general cleaners, masks, and other immediately necessary items. While it will take some time (12-18 months) to devise and produce a vaccine, medicines to treat people with coronavirus could be available sooner. Such medicines would not make the pandemic go away but they would alleviate suffering and reduce the number of deaths from this modern day plague.
What Sorts of Treatments Are Possible?
Modern science has found several possible ways to treat and cure Covid-19. Some are in the research pipeline and others are already-existing drugs that are being tested to see if they help. These include medicines used for years to prevent and treat malaria and a medicine originally developed (but not successful) to treat Ebola but which has been found useful for SARS.
Fujifilm Toyama Chemical (Japan) is testing Favipirar (Avigan). This drug has been used to treat mild cases of influenza and was approved in Japan for experimental treatment of Covid-19 cases. News reports from Wuhan, China say it is “safe and effective” although these results are not replicated elsewhere. The drug blocks viruses from replicating and reports indicate that it shortens the course of the disease, especially in those with pulmonary complications. There are no results available in studies in peer-reviewed journals.
Old Drugs for Malaria
For decades doctors have prescribed chloroquine or hydroxychloroquine for prophylaxis when people visit malaria-infested parts of the world. The drugs are also used in higher doses to treat active cases. Additional uses of these drugs include treatment for rheumatoid arthritis and lupus. Lab evidence from cells of humans and other primates suggests the drugs could help treat Covid-19. The evidence is based on a 2005 study of SARS in which the drugs impeded replication of the virus. Dr. Fauci of the National Institute of Allergy and Infectious Disease stated on a CNN interview that the drugs are being tested on Covid-19 cases at the Nebraska Medical Center. He noted that there have to be controlled studies of safety, effectiveness, and useable dosage in order to advise doctors to start using these drugs in all Covid-19 cases.
Additionally, the University of Minnesota is looking at the use of hydroxychloroquine for individuals who are living with infected people to see if (as with the use of the drug for malaria) it helps keep folks from catching the disease when exposed.
Years ago in France, doctors looked at using hydroxychloroquine with and without the antibiotic azithromycin for SARS patients. They reported that levels of the SARS coronavirus fell faster when hydroxychloroquine was used and even faster when azithromycin was added. Unfortunately, the doctors did not include in their report whether or not people recovered faster (or at all). A concern with this drug combination is that it can be lethal for people with kidney failure and can interact with other drugs and cause heart rhythm problems.
Remdesvir, the Drug That Did Not Work for Ebola
Gilead Sciences developed a drug during the Ebola outbreak. It did not help Ebola but did slow the growth of SARS and the similar MERS viruses. In the lab this drug prevents the viruses from infecting human cells. (Published in a February 2020 issue of Nature)
The FDA has approved its use for “compassionate use” in severe cases of Covid-19. It is under study both in the USA and China in five separate clinical trials to see if it can shorten the course of the disease and cut down on complications.
The World Health Organization has stated that this is the only drug that currently shows tangible promise. Anecdotal evidence of rapid recoveries is promising but the true picture will only emerge once controlled studies are done.
Side effects of this drug can include nausea, vomiting, rectal bleeding, and liver enzyme elevation.
HIV Drugs Don’t Seem to Help
There was hope that an antiviral combination used to treat HIV (lopinavir and ritonavir = kaleta) would help. However, the New England Journal of Medicine just published (March 18, 2020) a study from China showing no benefit.
More studies are underway.
Medication to Reduce Inflammation
Death from Covid-19 is often the result of a so-called “cytokine storm.” Cytokines are part of your immune system and help fight infections. Unfortunately, in severe cases of Covid-19 the body produces too many and they cause damage to the lungs.
Doctors have used an immunosuppressant drug (tocilzumag=Actemra) in trying to block this effect. The drug is normally used for both adult and juvenile forms of rheumatoid arthritis. It works by binding to a cytokine called IL-6 or interleukin 6. Trials have just stared sponsored by Roche to see if treatment outcomes are improved when adding this drug to standard treatments.
In a similar approach, Regeneron is working with and testing the IL-6 inhibitor sarilumab or kevzara.
Blood Pressure Drugs to Treat (or worsen) Covid-19
The blood pressure drug, Losartan, is being studied at the University of Minnesota to see if 1) it can prevent multi-organ failure in Covid-19 and even the need to be hospitalized.
The drug blocks receptors in a manner that prevents blood pressure from going up. Because SARS binds to the same receptors the thinking is that the drug may help.
The downside the blood pressure idea is that use of these drugs could end up causing the body to produce more receptors and make it easier for Covid-19 to get into human cells. Of 355 Italian patients who died of Covid-19, three-fourths had hypertension. The authors of the study in this case were concerned that the use of this sort of drug could be dangerous in cases of Covid-19!
Other Possible Treatments
Almost a century ago doctors took the serum of patients who had recovered from infectious diseases and used the antibodies they had produced to treat other patients. This approach is possible today using monoclonal antibodies. Today it is not necessary to collect serum for every bit of antibody as antibodies can be produced in the lab.
There is a long but informative article in Wired about the use of this approach.
While drugs to treat this disease (except perhaps hydroxychloroquine) will not prevent the disease, they will make people better faster and reduce the fatality rate.