While most people who get COVID-19 are able to recover at home, the rush is on to find a treatment that’s safe and effective against serious, life-threatening cases of the disease.
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Experts in laboratories and hospitals across the world are conducting hundreds of studies exploring whether different medications can help people with COVID-19. So, are any of them effective?
The short answer is that we’re still figuring that out. But we’ve come a long way since the start of the pandemic.
“As time has progressed, clinicians have all learned a lot about this disease, and our ability to take care of these patients has gotten better,” says pulmonary and critical care physician Lokesh Venkateshaiah, MD.
Below is a look at some of the treatments you might be hearing about in the news.
There are still questions about the effectiveness of remdesivir, the first drug approved by the Food and Drug Administration specifically as a treatment for COVID-19.
It’s an antiviral drug that’s given through an IV to patients over age 12 who are hospitalized with breathing problems related to COVID-19. It’s often given alongside a steroid call dexamethasone (which we’ll discuss in a moment).
“Hospitalized patients who have oxygen saturation levels less than 93% or have new supplemental oxygen needs are the ones who seem to benefit the most from this particular medication,” Dr. Venkateshaiah says.
In early research, hospitalized COVID-19 patients who met the criteria and got remdesivir had shorter stays in the hospital. There was also a suggestion that they were less likely to die. But a larger, more recent World Health Organization study did not show such remarkable results, Dr. Venkateshaiah says.
“It’s hard to tell. We need more data – but based on the information that’s available, we get the feeling that remdesivir and dexamethasone are making a difference,” he says.
Many serious cases of COVID-19 result from the body’s immune system overreacting to the coronavirus that causes the disease and, in turn, attacking healthy tissues and cells. This can cause inflammation and damage to the lungs and other organs.
Doctors use a class of medicines called corticosteroids – including one called dexamethasone – to help tame that response. These are medications that have been around for a long time and are readily available. “We know this medication very well. It’s been used for many other purposes, and we know the side effects profile and what it can do to the body,” Dr. Venkateshaiah says.
Its use to treat COVID-19 stems from the success of the RECOVERY trial carried out by researchers in the United Kingdom. In the study, hospitalized patients with COVID-19 who received dexamethasone for up to 10 days were less likely to die than those who didn’t. That benefit was only seen in very sick patients – those who had oxygen levels less than 93% or needed supplemental oxygen.
“There has been no other study that I can recall that has changed practice almost overnight throughout the world the way this one did,” Dr. Venkateshaiah says.
Dexamethasone is taken by mouth or given through an IV to very sick patients – often along with remdesivir. “We are starting to see some improvement in mortality numbers,” he adds.
But, doctors have to be careful with dosing. “Overdoing it with this drug can potentially put patients at risk for new infections, especially bacterial infections, or even fungal infections,” he cautions.
Convalescent plasma therapy
Convalescent plasma therapy involves the idea of “borrowing” antibodies – which are proteins the immune system makes to fight off an infection – from someone who’s recovered from a disease and giving them to someone who’s very sick. It’s been explored for a lot of different ailments over the last century.
“The feeling is that patients who get better from an infection probably mounted an antibody response to the infection in a greater way, and once they produce antibodies, they will likely have antibodies in their system for a few weeks or months at a very high level,” Dr. Venkateshaiah explains. “So we obtain blood from someone who’s recovered from COVID-19, take out the plasma (the part of the blood that would contain the antibodies) and give it to a patient who is not doing so well from a viral infection. The idea is that maybe the borrowed antibodies could potentially help the patient fight the infection better.”
The FDA allows hospitals to use convalescent plasma therapy for patients who are very sick with COVID-19. However, it’s not yet clear whether it’s effective at helping people recover.
Though some small clinical trials have been done, there’s a lack of reliable data from randomized, controlled trials (the most reliable kind) showing whether it’s effective.
The most recent COVID-19 treatments given FDA emergency use authorization are different from the rest. Rather than being given to very sick patients in the hospital, they’re being given by IV infusion to prevent people from needing to be hospitalized in the first place.
Monoclonal antibodies use lab-made proteins that mimic antibodies to reduce the amount of coronavirus in a person’s body – hopefully before it gets to a level that could cause severe symptoms and land them in the hospital.
Monoclonal antibodies are approved for patients who have COVID-19 and are at a greater risk for developing complications. This includes people over the age of 65 and people with certain preexisting medical conditions such as diabetes, chronic kidney disease or obesity.
“In studies, it was found that, with the early use of this medication, quite a few patients were able to stay out of trouble,” Dr. Venkateshaiah says. “The risk of hospitalization was lower with the medicine versus without it.”
As with the other medicines, its safety and effectiveness will continue to be studied.
With hundreds of clinical trials underway, are there more effective coronavirus treatments on the way?
“Truth be told, I don’t foresee medications being approved left and right in the near future,” Dr. Venkateshaiah says. “I also don’t think we’ll find a miracle drug to take care of this.”
Rather, it’s prevention that’s the best form of cure, he says. A likely approach to ending the pandemic includes a focus on prevention, including safety precautions like physical distancing and masking, and a vaccine. “I think when a vaccine becomes available, that’s going to be the real game-changer, provided that people are willing to take it,” he says.