Coronavirus Drugs (COVID-19): Approved and Under Study

Coronavirus Drugs

Currently, there are no known remedies capable of effectively eliminating the new coronavirus from the body and, therefore, in most cases, treatment is done with only a few measures and medications capable of relieving the symptoms of COVID-19.

Milder cases, with symptoms similar to common flu, can be treated at home with rest, hydration and the use of fever medicines and pain relievers. The most serious cases, on the other hand, in which more intense symptoms and complications such as pneumonia appear, need to be treated during hospitalization, often in Intensive Care Units, to ensure, mainly, the adequate administration of oxygen and the monitoring of vital signs.

In addition, there are some drugs that are being administered in hospitals and others that are being studied in clinical trials, with the aim of identifying a substance that is capable of eliminating the virus from the human body and facilitating recovery.

Approved remedies for coronavirus

The drugs that are approved for the treatment of coronavirus are those capable of relieving the symptoms of the infection, such as:

  • Antipyretics: to lower the temperature and fight fever;
  • Analgesics: to relieve muscle pain throughout the body;
  • Antibiotics: to treat possible bacterial infections that may arise with COVID-19

These remedies should only be used under the guidance of a doctor and, although they are approved for the treatment of the new coronavirus, they are not able to eliminate the virus from the body, but are only used to relieve symptoms and improve the comfort of the infected person.

Remedies being studied

In addition to drugs that help relieve symptoms, several countries such as the United States, China, Japan and Italy are developing studies on patients to try to identify a drug that can eliminate the virus from the body.

The drugs being studied should not be used without the guidance of a doctor, or as a means of preventing infection, as they can cause various side effects and be life-threatening.

The main types of drugs being studied for the new coronavirus are:

1. Remdesivir

This is a broad-spectrum antiviral drug that was developed to treat the Ebola virus epidemic, but it has not shown a positive results as other substances. However, due to its wide action against viruses, it is being studied to understand if it can have better results in the elimination of the new coronavirus.

The first laboratory studies with this drug, both in the United States and in China, showed promising effects since the substance was able to prevent the replication and multiplication of the new coronavirus, as well as and other viruses in the coronavirus family.

However, before it can be advised as a form of treatment, this medicine needs to undergo several studies with humans, to understand its true efficacy and safety. Thus, there are, at the moment, about 6 studies that are being carried out with a high number of patients infected with COVID-19, both in the United States, Europe and Japan, but the results should only be released in April, for the moment, there is no evidence that Remdesivir can, in fact, be used safely to eliminate the new coronavirus in humans.

April 29, 2020 Update:

According to an investigation carried out by Gilead Sciences, in the United States, the use of Remdesivir in patients with COVID-19 seems to present the same results in a treatment period of 5 or 10 days, with patients being discharged in both cases. from the hospital in about 14 days and the incidence of side effects is also low. This study does not indicate the degree of effectiveness of the drug to eliminate the new coronavirus and, therefore, other studies are still being done.

May 16, 2020 Update:

A study carried out in China in 237 patients with severe effects of the COVID-19 infection reported that the patients treated with this drug showed a slightly faster recovery compared to the control patients, with an average of 10 days compared to the control patients. 14 days presented by the placebo treated group.

Update May 22, 2020:

The preliminary report of another investigation carried out in the United States with Remdesivir also pointed out that the use of this drug appears to reduce recovery time in hospitalized adults, as well as decrease the risk of lower respiratory tract infection.

2. Dexamethasone

Dexamethasone is a type of corticoid widely used in patients with chronic respiratory problems, such as asthma, but it can also be used in other inflammatory problems, such as arthritis or skin inflammation. This medication has been tested as a way to reduce the symptoms of COVID-19, as it can help to reduce inflammation in the body.

According to a study being done in the United Kingdom, dexamethasone appears to be the first drug tested to greatly reduce the death rate of critically ill patients with COVID-19. According to the results of the study, dexamethasone was able to decrease the mortality rate by up to ⅓ 28 days after infection with the new coronavirus, especially in people who need to be assisted with a ventilator or to administer oxygen.

It is important to remember that dexamethasone does not eliminate the coronavirus from the body, only helping to relieve symptoms and avoid more serious complications.

June 19, 2020 Update:

The Brazilian Society of Infectious Diseases recommended the use of dexamethasone for 10 days for the treatment of all patients with COVID-19 admitted to the ICU with mechanical ventilation or who need to receive oxygen. However, corticosteroids should not be used in mild cases or as a means of preventing infection.

3. Hydroxychloroquine and chloroquine

Hydroxychloroquine, as well as chloroquine, are two substances that are used to treat patients with malaria, lupus and some other specific health problems, but which are still not considered safe in all cases of COVID-19.

Studies carried out in France and China, showed promising effects of chloroquine and hydroxychloroquine in reducing viral load and decreasing the transport of the virus into cells, reducing the ability of the virus to multiply, providing, therefore, a faster recovery. However, these studies were performed on small samples and not all tests were positive.

For now, according to the Ministry of Health of Brazil, chloroquine can only be used in people admitted to the hospital, for 5 days, under permanent observation, to assess the appearance of possible serious side effects, such as heart problems or changes in vision.

April 4, 2020 Update:

One of the ongoing studies, with the combined use of hydroxychloroquine and the antibiotic azithromycin, in France, showed promising results in a group of 80 patients with moderate symptoms of COVID-19. In this group, a marked decrease in the viral load of the new coronavirus in the body was identified, after about 8 days of treatment, which is less than the average of 3 weeks presented by people who did not undergo any specific treatment.

In this investigation, of the 80 patients studied, only 1 person died, as he would have been admitted to the hospital at a very advanced stage of the infection, which may have hindered treatment.

These results continue to support the theory that the use of hydroxychloroquine can be a safe way to treat COVID-19 infection, especially in cases of mild to moderate symptoms, in addition to decreasing the risk of disease transmission. Even so, it is necessary to wait for the results of other studies that are being carried out with the drug, to obtain results with a larger population sample.

April 23, 2020 Update:

The Federal Council of Medicine of Brazil approved the use of Hydroxychloroquine in combination with Azithromycin at the discretion of the physician, in patients with mild or moderate symptoms, but who do not require ICU admission, in which other viral infections, such as Influenza or H1N1, and the diagnosis of COVID-19 is confirmed.

Thus, due to the lack of robust scientific results, this combination of drugs should only be used with the patient’s consent and with the doctor’s recommendation, after assessing the possible risks.

Update May 22, 2020:

According to a study carried out in the United States with 811 patients, the use of Chloroquine and Hydroxychloroquine, associated or not with azithromycin, does not seem to have beneficial effects in the treatment of COVID-19, even seeming to double the rate patient mortality, as these drugs increase the risk of heart problems, especially arrhythmia and atrial fibrillation.

So far, this is the largest study done with hydroxychloroquine and chloroquine. Since the results presented go against what has been said about these drugs, further studies are still needed.

May 25, 2020 Update:

The World Health Organization (WHO) has temporarily suspended research on hydroxychloroquine that it coordinated in several countries. The suspension should be maintained until the safety of the drug is reassessed.

May 30, 2020 Update:

Espírito Santo State, in Brazil, withdrew the indication of the use of chloroquine in patients with COVID-19 in serious condition.

In addition, prosecutors from the Federal Public Ministry of São Paulo, Rio de Janeiro, Sergipe and Pernambuco ask for suspension of the regulations that indicate the use of hydroxychloroquine and chloroquine in the treatment of patients with COVID-19.

June 4, 2020 Update:

The Lancet magazine withdrew the publication of the study of 811 patients that demonstrated that the use of hydroxychloroquine and chloroquine did not have beneficial effects for the treatment of COVID-19, due to the difficulty in accessing the primary data presented in the study.

June 15, 2020 Update:

The FDA, which is the United States’ main drug regulatory agency, has withdrawn emergency permission for the use of chloroquine and hydroxychloroquine in the treatment of COVID-19, giving justification for the high level of risk of the drug and the apparent low potentials for the treatment of the new coronavirus.

4. Mefloquine

Mefloquine is a drug indicated for the prevention and treatment of malaria, in people who intend to travel to endemic areas. Based on studies that have been done in China and Italy, a therapeutic regimen in which mefloquine is combined with other drugs is being studied in Russia to verify its effectiveness in controlling COVID-19 disease, but there are still no conclusive results.

Thus, the use of mefloquine to treat infection with the new coronavirus is not yet recommended because further studies are needed to prove its efficacy and safety. 

5. Ivermectin

Ivermectin is a vermifuge indicated for the treatment of parasite infestations, which cause problems such as onchocerciasis, elephantiasis, pediculosis (lice), ascariasis (roundworms), scabies or intestinal strongyloidiasis and which recently showed very positive results in the elimination of the new coronavirus, in vitro.

A study carried out in Australia, tested ivermectin in the laboratory, in cell cultures in vitro, and found that this substance was able to eliminate the SARS-CoV-2 virus in 48 hours. However, clinical trials in humans are needed to verify its in vivo efficacy, as well as the therapeutic dose and safety of the drug, which is expected to happen in a period between 6 to 9 months.

6. Tocilizumab

Tocilizumab is a medication that decreases the action of the immune system and, therefore, it is normally used in the treatment of patients with rheumatoid arthritis, to decrease the exacerbated immune response, reducing inflammation and relieving symptoms.

This medication is being studied to assist in the treatment of COVID-19, especially in the more advanced stages of infection, when there is a large number of inflammatory substances being produced by the immune system, which can worsen the clinical condition.

According to a study conducted in China in 15 patients infected with COVID-19, the use of tocilizumab has been shown to be more effective and cause fewer side effects, compared to corticosteroids, which are the drugs commonly used to control inflammation generated by the immune response.

Still, more studies need to be carried out to understand what the best dose is, determine the treatment regimen and find out what are the possible side effects.

April 29, 2020 Update:

According to a new study done in China with 21 patients infected with COVID-19, treatment with tocilizumab appears to be able to reduce the symptoms of the infection soon after administration of the drug, decreasing fever, relieving the feeling of tightness in the chest and improving oxygen levels.

This study was done in patients with severe symptoms of the infection and suggests that treatment with tocilizumab should be started as soon as possible when the patient goes from a moderate situation to a serious situation of infection with the new coronavirus.

7. Convalescent plasma

Convalescent plasma is a type of biological treatment in which a blood sample is taken, from people who have already been infected with the coronavirus and who are recovered, who then undergo some centrifugation processes to separate the plasma from the red blood cells. Finally, this plasma is injected into the sick person to help the immune system fight the virus.

The theory behind this type of treatment is that the antibodies that were produced by the body of the person who was infected, and that remained in the plasma, can be transferred to the blood of another person who is still with the disease, helping to strengthen the immunity and facilitating the elimination of the virus.

Natural remedy options for coronavirus

To date, there are no proven natural remedies to eliminate coronavirus and help cure COVID-19, however, WHO recognizes that the Artemisia annua plant may help with treatment, especially in places where access to medicines is more difficult and the plant is used in traditional medicine, as it is in several regions of Africa.

The leaves of the Artemisia annua plant are traditionally used in Africa to help treat malaria and, therefore, WHO recognizes the need for studies to be valid to understand whether the plant can also be used in the treatment of COVID-19, since some synthetic malaria drugs have also shown promising results.

Still, it is important to remember that the use of the plant has not been confirmed against COVID-19 and that further investigation is needed and also always keep the social distancing in mind and take to the advice set by the government to stay safe as there is no Coronavirus drugs in circulation anywhere.

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