The Latest in COVID-19 Therapies
While hopes for an effective COVID-19 vaccine tops doctors’ and nurses’ wish lists, scientists are also working hard to conceptualize and test new treatments for the disease.
As we have heard, current treatments for COVID-19 are scarce. The first and most common treatment is “supportive therapy.” The aim of supportive therapy is to relieve symptoms and help the patient endure the disease with the hope that they will be able to fight the illness themselves. Doctors ensure patients have plenty of fluids, watch patients’ blood pressure, keep fevers down, and treat cough. If symptoms worsen, they can help people breathe by providing extra oxygen, sometimes by mechanical means.
The good news is that there are 2,251 COVID-19 observational studies and clinical trials listed at clinicaltrials.gov. Here’s a quick review of the most promising ones:
More than 100 scientist groups are studying whether giving an ill person a transfusion of plasma, a part of the blood, from someone who has recovered from COVID-19 will help the sick person recover. It’s called convalescent plasma transfusion, and it was given emergency use approval in March.
This type of treatment has an almost 100-year history for helping to treat diseases like rabies, hepatitis B, polio, measles, and influenza. Small studies confirmed that convalescent plasma helped clear the MERS and SARS viruses safely and more quickly, especially when given early in the disease course. This is promising, because MERS and SARS are very similar in shape and behavior to COVID-19. More than 7,000 units of convalescent plasma have been given to 5,000 patients in the United States.
In early May, the Food and Drug Administration authorized emergency use of the antiviral drug remdesivir. Thirty-five scientist groups are trialing the drug, which is designed to block an enzyme the virus needs to replicate. Preliminary results of a clinical trial showed that patients who received remdesivir recovered in 11 days, as opposed to 15 days.
Even with positive early results, the drug is a still a long way from approval. It is reserved for only those with severe illness; however, it may have more usefulness in patients who are not yet severely ill or on a ventilator. Dartmouth-Hitchcock Medical Center is one of the largest sites doing remdesivir research. Patients from SVMC have been transferred and have entered these studies at Dartmouth when appropriate. Vermont has recently been allocated treatment courses of remdisivir, and SVMC expects to receive some to use in our own patients if they fulfill clinical criteria.
At clinicaltrials.gov, you may recognize names like chloroquine and hydroxychloroquine, which are associated with 75 of the studies. In nearly all of these studies, these two drugs have been either harmful or showed no advantage over placebo. Their use for COVID-19 has been curtailed or stopped in nearly all U.S. medical facilities as well as those around the world.
Several newer agents, which are under study, are drugs that you have likely never heard of: Duvelisb, Infliximab, Desferal, Dornase Alpha, and Favipiavir. Whether any of these will become a household name famous for defeating COVID-19 is still a long way from certain.
||Number of People
||10 - 15
Learn how a drug is processed and how it affects the body
||15 – 30
Evaluate drug safety, often by giving different dosages. This ideally finds dose or dose range that has the therapeutic effect with the fewest side effects.
||40 – 90
Determine if the drug works and in what combination, assess safety
||100 or more
Compare drug to those currently accepted as the standard of care. Needed before approval by the FDA.
||Hundreds or thousands
Discover rare side effects and learn more about how well the drug works and whether it’s helpful when used in combination with other treatments.
One set of scientists from the University of Texas in collaboration with a Belgian research team is looking into llama (yes, the South American pack animal) antibodies, which are already a quarter of the size of those found in humans. Known as “nanobodies,” they latch onto the spikey proteins on the outside of corona viruses and prevent them from entering human cells, a necessary step in replicating themselves and making us sick.
Initially, the nanobodies fused to the coronavirus and then unfused quickly. The scientist engineered the microbes to stick harder, which worked to keep the virus from entering cells during laboratory experiments. It is one of the first antibodies known to neutralize the novel coronavirus. Maybe one day, llamas’ specialized antibodies will be infused into those who are sick or as a preventive measure in those who are at high risk.
While we are still a long way from finding a surefire hospital or home treatment, it is reassuring that principal investigators and research teams are working hard to discover new treatments at hospitals and universities around the world. Until then, it is as important to use the tried and true methods for preventing COVID-19, including handwashing, distancing, and masking.
Marie George, MD, is the infectious disease specialist at Southwestern Vermont Medical Center.