COVID-19 Medicines: Are There Any That Work?

COVID-19 Medicines: Are there any that work?

Daniel C. DeSimone, M.D. ：

It is the only drug approved by the U.S. Food and Drug Administration (FDA) for the treatment of coronavirus disease 2019 (COVID-19). But many other drugs are already in trials.

The FDA has now approved the antiviral drug remdesivir (Veklury) to treat COVID-19 in adults and children 12 and older. Remdesivir may be prescribed to hospitalized patients with COVID-19 who require supplemental oxygen or who are at high risk for severe illness. This medication is given by injection (into a vein) through the skin.

The FDA has approved the drug Paxlovid for emergency use. Each sachet contains two drugs: Naimatevir, which blocks the activity of a specific enzyme required for the replication of the virus that causes COVID-19; and the antiviral drug ritonavir, which helps slow down the Breakdown of Naimatevir. Paxlovid is approved to treat mild-to-moderate COVID-19 patients 12 years of age and older who are at higher risk for severe illness. These medicines come in tablets and are taken by mouth.

The FDA has approved another drug called monuprevir for emergency use to treat adult patients with mild to moderate COVID-19 who are at higher risk of becoming seriously ill and who cannot take other treatment options. These medicines come in tablets and are taken by mouth.

The FDA has approved the emergency use of the rheumatoid arthritis drug baricitinib (Olumiant) to treat COVID-19 in certain circumstances. Baricitinib tablets appear to fight COVID-19 by reducing inflammation and exerting antiviral activity. Baricitinib can be used in hospitalized patients with COVID-19 who are on mechanical ventilators or require supplemental oxygen.

Researchers are studying other potential treatments for COVID-19, including:

Antiviral drugs. Researchers are experimenting with the antiviral drugs favipiravir and merimepodib. The study found that the combination of lopinavir and ritonavir was less effective.

Anti-inflammatory therapy. Researchers have studied many anti-inflammatory drugs to treat or prevent multiple organ dysfunction and lung injury caused by infection-related inflammation.

Dexamethasone. The corticosteroid dexamethasone is an anti-inflammatory drug currently under investigation for the treatment or prevention of organ dysfunction and lung injury caused by inflammation. The study found that the drug reduced the risk of death by about 30 percent in patients on ventilators and about 20 percent in those who needed supplemental oxygen.

The National Institutes of Health recommends dexamethasone for hospitalized patients with COVID-19 who are on mechanical ventilators or require supplemental oxygen. If dexamethasone is not available, other corticosteroids such as prednisone, methylprednisolone, or hydrocortisone may be used. For less severe COVID-19 infections, dexamethasone and other corticosteroids may be more harmful than helpful.

In some cases, remdesivir, tocilizumab, or baricitinib can be combined with dexamethasone for hospitalized patients who are on a mechanical ventilator or need supplemental oxygen.

Immunotherapy. Researchers have studied immunotherapies such as convalescent plasma, mesenchymal stem cells, and monoclonal antibodies. Monoclonal antibodies are proteins developed in the laboratory that help the immune system fight off viruses.

Monoclonal antibody drugs include sotovelumab, banivirumab combined with eltersuvirumab, and casirimumab combined with idelweimab. These medicines are used to treat people with mild to moderate COVID-19 who are at higher risk of becoming seriously ill from COVID-19. Treatment consists of giving as a single infusion (into a vein) in your arm as an outpatient. For best results, these drugs need to be given shortly after symptoms of COVID-19 appear and before hospitalization. Some monoclonal antibodies are less effective against certain variants of COVID-19.

The researchers also investigated convalescent plasma immunotherapy. The FDA has approved the emergency use of convalescent plasma therapy to treat COVID-19. Convalescent plasma is blood donated by recovered COVID-19 patients. Convalescent plasma with high antibody levels could be used to treat some hospitalized patients with COVID-19 who are in the early stages of the disease or who are immunocompromised.

Investigational drugs for which effectiveness is uncertain. The researchers studied amlodipine and losartan. But it's not clear how effective these drugs are for treating or preventing COVID-19. Famotidine is not considered beneficial in treating COVID-19.

Ivermectin. The drug ivermectin is used to treat or prevent parasites in animals and people, not to treat viruses. This drug has not been approved by the FDA to treat or prevent COVID-19. This medicine may cause serious injury if taken in large amounts. Never self-medicate animals to treat or prevent COVID-19.

Hydroxychloroquine and chloroquine. These antimalarial drugs were previously authorized for emergency use by the FDA during the COVID-19 outbreak. But the FDA withdrew the authorization when an analysis of the data showed the drugs were ineffective in treating COVID-19. These drugs can also cause serious heart problems.

Medicines to prevent COVID-19. Researchers are studying drugs to prevent COVID-19 before and after exposure to the virus.

The FDA has authorized emergency use of the monoclonal antibodies cabirimumab in combination with idevumab and banivirumab in combination with eltersuvirumab. These medicines can be used to treat people who have recently been exposed to the COVID-19 virus or who are at high risk of exposure and who are at higher risk of becoming seriously ill. Once someone in a nursing home or prison has recently been infected with the COVID-19 virus, those at high risk of exposure may include people who live there. This treatment is for people who have not been fully vaccinated or who are fully vaccinated but are immunocompromised.

The FDA also approved the emergency use of the monoclonal antibody tesagravirumab in combination with sigavirumab (Evusheld) for the prevention of COVID-19 in some immunocompromised populations or those with a history of severe reactions to the COVID-19 vaccine.

It is not known whether these drugs are effective against COVID-19. It is important to complete medical studies to see if these drugs work against COVID-19.

Even if you've heard that these medicines may help, don't try them without a prescription and your doctor's approval. These medicines can have serious side effects. These medicines are reserved for seriously ill people who need the care of medical staff.

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Daniel C. DeSimone, M.D.