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With a vaccine not looking likely this side of Christmas, scientists and health experts are scrabbling to find existing drugs that can help fight against the worst effects of Covid-19.
The Recovery trial in the UK has already unearthed one game-changing drug, dexamethasone, and has crossed two other treatments off the list after they didn’t show any clinical benefits. The first is hydroxychloroquine, the drug fiercely advocated for by Donald Trump despite studies showing it’s not effective; the other is lopinavir-ritonavir, a drug commonly used to treat HIV.
More than 11,500 Covid-19 patients from over 175 NHS hospitals in the UK have been enrolled on the trial with a view to finding treatments that reduce deaths and the need for mechanical ventilation.
Here’s what you need to know about the drugs currently being tested, as well as those already in use for treating the virus.
What is it? Remdesivir is an antiviral drug that was originally developed to treat ebola but was dropped from trials after other drugs were found to be more effective.
What’s the deal? The experimental drug, produced by US pharmaceutical company Gilead, was revived as a potential treatment for coronavirus after animal trials showed it had some impact fighting other strains of coronavirus: MERs and SARs.
The aim of antiviral drugs is to directly target a virus (such as Covid-19) and either kill it or prevent it from spreading.
The drug is being trialled worldwide with data suggesting it can shorten recovery time by approximately four days in hospitalised patients. Results have also shown a small trend toward better survival rates for the drug – 8% of patients given remdesivir died, compared to 11.6% in the placebo group. However, scientists admitted the difference wasn’t significant enough to be sure it was down to the effect of the drug.
The Department of Health and Social Care has approved the drug for limited use in the UK, which means it will be made available to selected patients in NHS hospitals.
What is it? Dexamethasone is a type of steroid that prevents the release of substances in the body that cause inflammation. It’s typically used to treat inflammatory conditions such as allergic disorders and skin conditions.
What’s the deal? As part of the UK’s Recovery trial, 2,104 patients were given dexamethasone once a day for 10 days and outcomes compared with 4,321 patients receiving usual care. The steroid reduced deaths by one third in ventilated patients and by one fifth in other patients receiving oxygen. There was no benefit found among patients who did not require respiratory support.
The drug works by suppressing the body’s immune response to Covid-19. This is important because in some people the immune system can go into complete overdrive and cause more havoc than the actual virus itself. As immunologist Dr Jenna Macciochi previously told HuffPost UK: “For some reason the natural brakes of our immune system fail and the inflammatory reaction overshoots.”
This can result in blocked airways, overwhelmed organs, and can potentially lead to multi-organ failure and death. The steroid drug, however, is thought to suppress this process.
Professor Peter Horby, an expert in emerging infectious diseases at University of Oxford and one of the chief investigators for the trial, said the survival benefit is “clear and large” in those patients sick enough to require oxygen treatment.
Dexamethasone is the first drug shown to improve survival in Covid-19 and is already being used to tackle the virus by the NHS. Its use is still being studied in children and is not suitable for mild cases.
What is it? SNG001 is an inhaled form of interferon beta, which is typically used to treat multiple sclerosis (MS). Interferon beta is a naturally occurring protein in the body which is made into a drug and used to reduce inflammation in the body.
One of the key impacts of the coronavirus is suppressing the body’s production of interferon beta, Richard Marsden, CEO of Synairgen, the company behind SNG001, told the BBC. The aim of the drug is to put the protein straight into the lungs of Covid-19 patients to help give them a fighting chance.
What’s the deal? A small clinical trial of the drug found it stopped the disease from progressing and in some cases sped up recovery. Patients who received SNG001 had a 79% lower risk of developing severe disease compared to placebo, and were more than twice as likely to recover from Covid-19 compared to those taking a placebo.
Over the treatment period, the measure of breathlessness was markedly reduced in patients who received SNG001 compared to those receiving the placebo. And there were no deaths among subjects treated with SNG001, compared to three from the placebo group.
The results haven’t been published in a peer-reviewed journal yet.
What is it? A commonly used antibiotic with antiviral and immunomodulatory properties (which basically means it modifies the immune response or the functioning of the immune system). It’s traditionally used to treat different types of infections caused by bacteria, such as respiratory infections, skin infections, ear infections, eye infections, and sexually transmitted diseases.
What’s the deal? Most studies to date have been conducted on hydroxychloroquine and azithromycin as a combination, so it’s been hard to gauge the drug’s potential as a treatment on its own. The reason it’s being trialled is because it’s thought azithromycin might have potential when it comes to handling the body’s immune response to Covid-19 and preventing it from going into overdrive (a key factor in most of treatments being trialled.)
Professor Martin Landray, an expert in medicine and epidemiology at the Nuffield Department of Population Health, University of Oxford, and deputy chief investigator of the Recovery trial, tells HuffPost UK: “Azithromycin is a macrolide antibiotic. In addition to their antimicrobial properties, macrolide antibiotics modify the response of the immune system by decreasing the production of cytokines, proteins that cause inflammation. In some patients, excessive levels of cytokines are released, resulting in a ‘cytokine storm’, a complication of Covid-19 which can kill the patient.
“We hope that azithromycin will show positive benefit for hospitalised Covid-19 patients but whether there is a benefit can only be determined by testing the treatment through a randomised controlled trial. We do not anticipate results until later in the year.”
Some experts are sceptical of whether the antibiotic will work. Writing in the journal Open Forum Infectious Diseases in June, Dr Jennifer Lighter and Dr Vanessa Raabe from New York University’s School of Medicine argued there is “no justifiable preclinical or clinical evidence” to suggest that the benefits of azithromycin for Covid-19 outweigh the risks of treatment, and warned that clinicians should stop prescribing it.
What is it? An anti-inflammatory treatment given by injection. It’s normally used to treat moderate to severe rheumatoid arthritis in adults, as well as cytokine release syndrome (CRS), which is caused by an overactive immune response to certain types of blood cell treatments for cancer.
What’s the deal? Tocilizumab is currently being trialled in the UK, and the timing of the results will depend on the scale of the epidemic in the coming months, Professor Landray tells HuffPost UK.
The drug has had a promising impact in Italy where a study of adults with severe Covid-19 pneumonia who were admitted to hospital during the height of the pandemic found that out of 544 patients with severe Covid-19 pneumonia, 16% of patients in the standard care group needed mechanical ventilation, compared with 18% of patients treated with tocilizumab.
One in five patients (20%) in the standard care group died, compared with 7% of patients treated with tocilizumab. The study’s authors concluded that treatment with tocilizumab “might reduce the risk of invasive mechanical ventilation or death in patients with severe Covid-19 pneumonia”.
One concern is that taking the drug can lead to other bacterial infections in the body. The same study from Italy found 13% of patients treated with tocilizumab were diagnosed with new infections, compared with only 4% of patients treated with standard of care alone.
What is it? Convalescent plasma is collected from donors, via their blood, who have recovered from Covid-19 and contains antibodies which help fight against the virus. The hope is that this antibody-rich plasma can be donated by recovered Covid patients and transfused into infected patients whose immune systems are struggling to fight the infection.
What’s the deal? There is some limited evidence that patients might benefit from the use of convalescent plasma. Clinical trials are now underway in the UK to confirm whether transfusions are safe and effective for treating Covid-19.
The first transfusion happened back in June and was given to a child – since then 300 people have received plasma. Professor Landray says: “We anticipate that much larger numbers will be needed before we have a clear result. Like the other treatments we are studying, there are good theoretical reasons to believe this treatment may be beneficial – but we need the evidence from this large randomised trial before we will know whether that hope is translated into real benefits for patients.”
NHS Blood and Transplant is appealing for people who have recovered from Covid-19 or the symptoms, and who live near one of its 23 donor centres, to offer to donate their plasma by calling 0300 123 23 23 or visiting www.nhsbt.nhs.uk.
Plasma donations from men are particularly welcomed, as figures show that 43% of male blood plasma donors have high antibodies, compared to 29% of women. Explaining why men might have a higher antibody count, Professor David Roberts, from NHS Blood and Transplant, said: “Our studies and many others around the world show men with Covid-19 are more likely to become seriously ill than women. This makes them better plasma donors once they’ve recovered.”
Researchers anticipate results from the plasma trial in the last quarter of 2020.