Do we already have a treatment for coronavirus (COVID-19)? Is President Trump right about chloroquine or is redesivir more promising for coronavirus? The biopharmaceutical industry is working to see if currently available medications could treat the illness COVID-19 causes. It’s important to note that drugs cannot be a cure for COVID-19 because viruses can’t be permanently stopped by anything but your own immune system. But treatments are being developed to address both the virus and the damage it causes.
A Two-Pronged Approach
So far, it looks like around 15% of patients infected with COVD-19 develop severe illness that requires hospitalization, and another 5% need treatment in the intensive care unit (ICU). One approach to treat COVID-19-related illness is to find medications that slow down — or even stop — the virus’s ability to reproduce. This could shorten the length of illness and prevent it from becoming severe or critical.
Researchers are also investigating drugs that stop the body’s autoimmune response in the critical stages of illness. If patients progress to severe illness, they can develop acute respiratory distress syndrome (ARDS), which isn’t caused by the virus, but by the body’s inflammatory response to it. Most of the deaths attributed to COVID-19 are from ARDS, so finding ways to reduce or halt the inflammatory response could result in fewer deaths.
It’s important to note that there isn’t enough scientific evidence about the safety or effectiveness of any of these drugs for them to have been approved by the U.S. Food & Drug Administration (FDA) to treat COVID-19. Larry Sasich, PharmD, MPH, a consultant for the FDA and the Saudi Arabian Food and Drug Authority, and co-author of Worst Pills, Best Pills, also points out that the side effects that we know about are in people who don’t have COVID-19.
Because we don’t know much about what can safely or effectively treat COVID-19 yet, it’s important to talk to your doctor about any medication that you’re considering using for COVID-19. Not only is there the possibility for dangerous side effects, but there are also potential drug interactions to consider, so it’s important to have medical supervision.
While we are a long way from having any definite answers yet, the fact that clinical trials are going on during a pandemic is encouraging.
Potentially Promising Treatments
Here’s a look at some of the drugs scientists are researching to see if they could be effective in treating COVID-19-related illness.
Remdesivir was originally formulated to fight Ebola. However, it was found to be basically ineffective against the Ebola virus during the 2019 outbreak in the Democratic Republic of the Congo.
What it’s currently used for: Remdesivir works by inhibiting a virus’s ability to replicate, but it isn’t approved to treat any type of condition or disease.
Clinical trials: There are three large-scale clinical trials going on in the United States to look at the effects of remdesivir in patients who are hospitalized with severe COVID-19-related illness. Other trials are going on worldwide as well, including a large global trial by the World Health Organization (WHO) called SOLIDARITY that’s testing four different drugs, including remdesivir.
The drug manufacturer, Gilead, has been flooded with requests for individual use as well but is recommending that people enroll in a clinical trial instead if at all possible.
Known serious side effects: Not a lot of information is available for this drug since it’s unapproved and only experimentally used. “One concerning bit about it is it does have a solubilizing agent in it called sulfobutylether-beta-cyclodextrin (SBECD),” says Michael Klepser, PharmD, FCCP, a professor at Ferris State University’s College of Pharmacy. “We’ve seen that solubilizer used with other medications and sometimes in patients with renal dysfunction, it can cause some problems because (the SBECD) can accumulate and cause kidney damage. That would be the major thing to keep an eye on.”
How it could help COVID-19 patients: In 2017, researchers found that remdesivir was effective against many different coronaviruses — including the ones that cause severe acute respiratory syndrome (SARS) — in both a mouse and in cell cultures. Two patients in the United States with COVID-19 were given remdesivir when the outbreak first started and have recovered.
“The idea is treating with remdesivir would prevent the viral infection from becoming established and would also shorten its duration once it’s already happening,” says Hana Akselrod, MD, an assistant professor of medicine in the infectious diseases division at the George Washington University School of Medicine and Health Sciences. “What’s not known with remdesivir is how effective it is because it was not originally developed for this specific virus. There have never been large numbers of patients treated with it, even with Ebola, and how it will perform against the novel coronavirus that causes COVID-19 is what’s being investigated right now.”
“This is one that I’m fairly excited about,” says Klepser. “I’m anxious to see some of the information from trials. This is the medication that most patients might end up having access to before trials.”
Potential risks for COVID-19 patients: “There are questions of what (remdesivir’s) potential toxicities and side effects will be, how it’s metabolized, what’s the correct dose to give, and when in the course of illness it would be most effective. And would it possibly interact with other drugs that the person is receiving?” Akselrod says.
Gilead plainly states on their site that remdesivir “has not been demonstrated to be safe or effective for any use.”
Ritonavir and Lopinavir
Ritonavir and lopinavir are antivirals used in a combination drug called Kaletra.
What it’s currently used for: Kaletra is FDA-approved to treat human immunodeficiency virus (HIV). This medication blocks the virus’s ability to copy its genetic material, says Akselrod. “This is a medication we’ve been using for many, many, many years to treat HIV and it’s a potent and effective antiviral, but for a virus that’s not in the same family as COVID-19,” she says.
Clinical trials: Kaletra is another drug being studied in WHO’s SOLIDARITY study, as well as Kaletra combined with interferon-beta.
Known serious side effects: There are a number of other medications that shouldn’t be taken with Kaletra because of the risk for serious drug interactions. Kaletra can also lead to pancreatitis, liver damage, heart rhythm abnormalities, increased cholesterol levels, and new or worsened diabetes.
How it could help COVID-19 patients: “It did show some potential promise against the novel coronavirus in laboratory studies where they tested in an artificial laboratory setting or in an animal model,” Akselrod notes. “There were reports of it being used clinically, from the early days of this epidemic.”
However, a recently-published clinical trial in China used Kaletra to treat COVID-19 patients hospitalized with pneumonia and the researchers found that it wasn’t effective. “For a drug that’s supposed to block the production of the virus, at least in that study, it didn’t seem to do much,” says Akselrod. “There are still other studies ongoing and we’re all keeping our ear to the ground on that.”
“The advantage with ritonavir/lopinavir is that it is widely available. It’s been around for many years, so there are ways to produce it on a mass scale to ensure quality,” Akselrod says. “And we also know how it behaves in terms of metabolism. It does have interactions with other drugs, which is a big caveat, but at least we know what those interactions are, whereas for a newly developed drug or for a drug that has never been tested in a large human population, we might just not know what those complications would be.”
Potential risks for COVID-19 patients: As with all these drugs, the potential risks for COVID-19 patients specifically are not clear but include unknown dosing and unknown duration of medication use. The only solid information we really have is “what’s in the professional product label for patients who don’t have COVID-19,” says Sasich.