COVID-19 cases are declining in most countries, but experts say that a second wave is likely. For our battered and bruised health care systems to have a chance at functioning well through a strong second wave, we must find effective treatments.
Recently, some promising breakthroughs in treatments tested have increased our chances of helping COVID-19 patients recover. Here are some drugs that may show promise.
Dexamethasone – first drug to reduce deaths
Dexamethasone is a steroid that reduces inflammation. It was tested as part of the Recovery trial, a large UK-based trial testing many treatments, partly funded by Bill and Melinda Gates. The results of the dexamethasone trial were announced on Tuesday in a press release. The results were encouraging, though we must wait for the published results before making definite conclusions.
The study is a large randomized controlled trial that assigned 2,104 patients to get dexamethasone, and 4,321 patients to get usual care. The drug reduced deaths by 35% in patients requiring breathing machines. It also reduced deaths by 20% in patients only needing supplemental oxygen. It did not show any benefit to patients with mild illness.
This is a significant result if it holds up under scrutiny because dexamethasone is a very affordable, easy-to-scale drug. The study also shows that only a small dosage is needed. Researchers estimate that one of every eight patients needing ventilation and one of every 25 patients needing extra oxygen would be saved.
This drug gained notoriety when President Trump included it in a tweet and then started taking the drug as a preventive measure.
One recent study made a splash when it suggested that hydroxychloroquine had a negative effect on survival in COVID-19 patients. However, the authors of this study retracted it when there were concerns raised about the validity of the data.
There are several recent studies that show more trials are needed before this drug is used for treatment. One recent randomized trial produced evidence that hydroxychloroquine did not prevent an illness similar to COVID-19. Another study suggested that treatment with hydroxychloroquine alone or with azithromycin, is not useful in treating hospitalized COVID-19 patients. Again, more research is needed before making definitive conclusions about this drug.
A highly-publicized trial released at the end of May suggested preliminarily that a drug called Remdesivir was effective against COVID-19. Receiving this drug for 10 days was more effective than a placebo in shortening hospitalization in COVID-19 and lower respiratory tract infection patients. More research is needed, but Remdesivir has given hope that it can help fight the pandemic.
Blood pressure medication
Much has been made of the strange symptoms that some COVID-19 patients have. Some evidence has linked these strange symptoms, including blood clots, strokes, heart attacks, and painful toes, to damage caused to endothelial cells – the cells that line the blood vessels. This has led to studies that examine blood pressure medication as a preventive treatment for COVID-19.
We are awaiting results that show significant effects of this treatment. Two of the most widely-used classes of blood pressure medication are ACEIs (Angiotensin-converting enzyme inhibitors) and ARBs (Angiotensin receptor blockers). A few studies have shown no relationship between taking ACEIs or ARBs and becoming infected with or getting a severe case of COVID-19.
Among other forms of blood pressure medication, evidence suggests RAAS blockers are not a factor in COVID-19 infection, but beta blockers are associated with a modestly lower likelihood of a positive test.
Lopinavir, an antiviral used in the treatment of HIV, has been viewed with hope from the beginning of the pandemic because of preliminary evidence for its effectiveness against other coronaviruses (along with ritonavir, which increases the half-life of lopinavir). So far there is little evidence that lopinavir works well against COVID-19 but more research is needed.
Early results had suggested that the drug be retained as a treatment option against COVID-19. A large phase 2 trial suggested that lopinavir-ritonavir, along with 2 others, was effective at reducing viral shedding compared to lopinavir-ritonavir alone.
Results from the latest trial showed this treatment did not improve recovery time or mortality rates among those in the trial with severe COVID-19.
Other COVID-19 treatments in trial
There are many other drugs or treatments being studied right now, including:
- Convalescent Plasma – When added to standard treatment it did not reduce time to improvement. More research is needed.
- Anakinra – Reduced the need for ventilation in the ICU and reduced mortality in severe cases.
- Vitamin D – Suggestion that it can play a role in improving COVID-19.
- Oxygenation – Non-invasive oxygenation vs. standard oxygen therapy significantly associated with reduced mortality.
- EIDD-2801 – Antiviral developed by not-for-profit biotech company has shown in animal studies it can reduce symptoms for other coronaviruses.
Where do COVID-19 treatment trials go from here?
COVID-19 is being studied at an unprecedented level. There are over 2,000 COVID-19 clinical trials worldwide. New drugs with potential to fight the novel coronavirus are being identified rapidly with the help of computing and artificial intelligence.
However, clinical research is still a complex process that must move at a deliberate pace to be effective. There are 2 drugs tested on humans that so far seem to have strong potential against COVID-19 – dexamethasone and Remdesivir. To fight a second wave of the coronavirus, more proven treatments will likely be needed. Government, academia, industry and the public need to work together to move the pace of research along as quickly as possible in case a strong second wave of the virus develops.
One way that clinical trials can ensure that they move quickly and efficiently is by using a clinical trials logistics firm. At Bay Area Research Logistics, we help with all aspects of clinical trial logistics, such as planning, packaging, labelling, storage and distribution. Please contact us if you need to jump-start your clinical trial.