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COVID-19 Treatment Updates: Remdesivir, Hydroxychloroquine, Favipiravir and Drugs for Coronavirus

Former Managing Director of Ahmedabad Stock Exchange
Jul 31, 2020 1:15 PM 4 min read
Editorial

Coronavirus disease 2019 (COVID-19) is defined as illness caused by a novel coronavirus now called severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2; formerly called 2019-nCoV), which was first identified amid an outbreak of respiratory illness cases in Wuhan City, Hubei Province, China

In order to thrive, viruses have four hurdles they need to overcome:

  1. Transmission they have to transmit from host to host
  2. Access, they need to bypass the security system of the human cell
  3. Replication, a virus must hijack the cell’s copy machinery to create copies of itself
  4. And Apoptosis, it needs to destroy the cell, and move out to infect other cells. 

 

Drugs for COVID-19

No drugs or biologics have been approved by the FDA for the prevention or treatment of COVID-19. Remdesivir gained emergency use authorization (EUA) from the FDA on May 1st 2020, based on preliminary data showing a faster time to recovery of hospitalized patients with severe disease. 

How Does Remdesivir Work to Fight COVID-19?

The genetic encoding of the SARS 2 coronavirus is a single stranded RNA. After cell entry, the virus co-opts the cell into producing copies. A key enzyme in this process is RNA polymerase which synthesis the nucleotide components that make up the RNA strand. Remdesivir appears to this enzyme as Adenosine one of the nucleotides. The RNA polymerase grabs Remdesivir and attaches it to the chain. But after doing so, further nucleotides are unable to attach, thereby terminating the replication process. By preventing the completion of the replication process, Remdesivir stops the pathogenesis for SARS-Coronavirus-2 . 

On June 2nd, the Government of India had approved the use of  Remdesivir in case of emergency to treat COVID-19 patients. In India, the main treatment given to the patients of COVID-19 was in the form of HIV Drugs i.e. Combination of Lopinavir and Ritonavir.

On Mar 31st, the Ministry of Health and Family Welfare had recommended off- label use of the combination of Hydroxychloroquine and Azithromycin for patients with severe infection of SARS-CoV2 and those requiring ICU management.

Medical authorities in China have said that a drug called favipiravir which is used in Japan to treat new strains of influenza have been effective in treating coronavirus patients. Patients who were given the medicine in Shenzhen turned negative for the virus after a median of 4 days after becoming positive. 

The US Food and Drug Administration (FDA) approved limited emergency use of chloroquine and hydroxychloroquine as a treatment for COVID-19. Doctors in Thailand have reportedly succeeded in using a combination of HIV drugs including lopinavir and ritonavir and the antiviral medication oseltamivir to treat coronavirus infected patients.

Few hospitals of the UK are going to test five new drugs named as Heparin, Bemcentini, Medi3506, Calquence, Zilucoplan in the coming days in search to combat the coronavirus. These drugs were chosen from a list of 200 potential candidates.

None of the above drugs have yet been proved to be universally applicable to every patient battling the novel coronavirus

 

COVID-19 Treatment Updates: Remdesivir, Hydroxychloroquine, Favipiravir and Drugs for Coronavirus

 

Treatment for COVID-19

Since last few months, plasma extracted from the recovered patients is helping in reducing the virus effect in critically ill patients. This treatment is known as convalescent plasma, which dates back centuries and was used during the flu pandemic of 1918. Some experts have argued that it might be the best hope for combating the coronavirus until more sophisticated therapies can be developed, which could take several months.

There are still no targeted therapies for the management of critically ill COVID-19 patients in ICU. Critical cases are characterized by exhibited respiratory failure, septic shock, and/or multiple organ dysfunction/failure. Dynamic monitoring and supportive treatment for the restoration of tissue vascularization and organ function are particularly important. 

Respiratory failure is the primary organ dysfunction, which worsens the prognosis of COVID-19 patients. Oxygen therapy and respiratory support are the key treatments for COVID-19. Assisted breathing system or supplementary oxygen supply basically consists of CPAP (continuous positive airway pressure), and BiPAP (bilevel positive airway pressure) machines. Both CPAP and BiPAP machines are not invasive and use masks placed on the patient’s face unlike ventilators that are invasive and require a tube to be inserted into the patient's airway passage through the mouth. A CPAP machine is used to deliver single pressure while a BiPAP machine is used to ensure regulated inhaling and exhaling pressure of a patient. NIV (Noninvasive ventilation support) and HFNC (High flow nasal cannula) oxygen delivery are important treatments for COVID-19 induced mild and moderate ARDS (Acute respiratory distress syndrome). 

Lung-protective strategy should be used in COVID-19-induced ARDS. Based on low lung recruitability in COVID-19-induced ARDS, high PEEP should probably not be used as per experts. PEEP (Positive end-expiratory pressure) setting should probably be based on various factors, including gas exchange, hemodynamics, lung recruitability, and driving pressure. 

Extracorporeal membrane oxygenation, or ECMO, is a therapy that adds oxygen to your loved one's blood and pumps it through their body like the heart. The process takes place outside the body. Experts recommend an early use of ECMO in COVID-19 patients with refractory hypoxemia or hypercapnia who have received invasive mechanical ventilation and prone positioning. 

Even though some clinical experts insisted that antiviral therapy is unnecessary for seriously ill patients with COVID-19 since the course of disease in severe types is longer than 2 weeks, multiple virus particles have been found at the lung lesions. Up to date, there is no specific antiviral drug that has been testified and globally recognized as effective for treating COVID-19. In China, several antiviral drugs such as ribavirin, ganciclovir, oseltamivir, arbidol, alpha-interferon, chloroquine, lopinavir–ritonavir, and remdesivir have been used in clinical settings for the treatment of COVID-19.  Medical experts also opine that there is some evidence that immunotherapy may be effective against novel coronavirus infection. Currently, there are several available immunomodulatory drugs such as glucocorticoid, thymosin, and immunoglobulin.

FIN.

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