The international research effort to find new therapies for COVID-19 is truly remarkable. The Doctors of the Therapeutic Clinic of the Medical School of the National and Kapodistrian University of Athens Theodora Psaltopoulou, Giannis Danasis, Panos Malandrakis and Thanos Dimopoulos (Rector of EKPA) summarize the available data. Recently, C. Zhang et al. Published a meta-analysis in the journal Frontiers Public Health on treatment options for COVID-19 that are being evaluated in clinical trials. The researchers collected data from 222 studies involving a total of 102,950 patients with COVID-19.
All possible therapeutic approaches were compared with the best supportive treatment. Imatinib, intravenous immunoglobulin and tocilizumab resulted in a reduced risk of death. The combination of baritsitinib with remedisivir, as well as colchicine, dexamethasone, recombinant granulocyte growth factor, and tocilizumab, were associated with a lower likelihood of mechanical ventilation. In addition, tofacitinib, sarilumab, remedisivir, and the combination of baristinimib with remedisivir increased the proportion of patients discharged from hospital. Also, recovering plasma, ivermectin with or without doxycycline, hydroxychloroquine, nitazoxanide and proxalutamide increased the clearance of SARS-CoV-2 virus from the body. Of course, it should be noted that for most of the previously reported medications the results do not relate to large phase 3 clinical trials that would potentially lead to the approval of new drugs. In addition, there may be special groups of patients who have the greatest benefit from receiving specific treatments. For example, plasma administration from recovering patients is most effective when administered within the first 3 days after the onset of symptoms and when it has high antibody titers to SARS-CoV-2.
In addition, monoclonal antibodies to COVID-19 are indicated for untreated patients aged 12 years and older with a diagnosis of mild to moderate COVID-19 and an increased risk of severe COVID-19 and complications. In other words, these are patients who do not need oxygen support, but have risk factors for serious disease such as: age 65 and over, body mass index (BMI) 35 and above, underlying diseases such as chronic kidney disease, diabetes, immunosuppression and immunosuppressive drugs. , cardiovascular disease, hypertension, chronic respiratory problems. Administration should be done as soon as possible after laboratory confirmation of COVID-19 and certainly less than 10 days after the onset of symptoms. To date, four monoclonal antibodies to COVID-19 have been approved for use on an urgent basis as they are still under evaluation for full marketing authorization. These include the combination of Bamlanivimab and Etesevimab (EliLilly), the combination of Casirivimab and Imdevimab (Regeneron), Regdanvimab (Celltrion) and Sotrovimab (GSK). The use of monoclonal antibodies in clinical protocols has led to a reduction in hospitalizations and deaths in patients with COVID-19, as well as a faster reduction in the viral load of SARS-CoV-2 compared with placebo.
Oral antiviral drugs are also important. In a related clinical study, non-hospitalized patients diagnosed with mild to moderate COVID-19 who received molnupiravir were almost 50% less likely to be hospitalized or terminated. Patients had co-morbidities, and were therefore at high risk of developing severe COVID-19 disease. Molnupiravir has been approved for use in the United Kingdom and a decision by regulators in Europe and the United States is pending. In addition, oral antiviral rhinovavir has been associated with a reduced risk of death or hospitalization due to COVID-19 by 89% compared with placebo in non-hospitalized high-risk patients with COVID-19. Finally, we must not forget that despite the therapeutic developments against COVID-19, the vaccine against SARS-CoV-2 is the most important weapon to stop the pandemic.
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