Almost six months had passed that Covid19 disease started and considered as one of the world’s worst pandemic in our modern history. As of the very moment in time no definite treatment has been develop for those severely and critically affected patients admitted in the hospital’s intensive care units, and a desperate moved was undertaken to save lives as much as possible…thus health authorities (WHO) used some repurposed drugs or medicines that showed promising results when given to CoviD19 patients. I want to mention here an updates of some popular repurposed drugs that are still currently use today for CoviD19 patients.

 


Recently Popular Repurposed Drugs:CoviD19

1.) Dexamethasone-– Is widely known, commonly cheap steroids with modest anti-inflammatory effect and it is given in patients with asthma,arthritis,skin allergies,bone marrow and blood cancers,psoriasis,lupus,nephritis and other inflammatory diseases.

 Then it was used as a repurposed drug for severely and critically ill CoviD19 patients and was found out to decrease death rate by one fifth or 20% if given to CoviD19 patients with oxygen and one third decrease of death rate on patients with ventilators admitted in the hospital.

The new findings was revealed by doctors at Oxford University in the United kingdom. Dr. Edward Oldfield a professor of Internal medicine at the East Virginia Medical School said that the drug is promising. 

The WHO Director general Tedros Adhanom Ghebreyesus PhD, is cautioning the health professional of using the drug dexamethasone(6 mg of dexamethasone given daily to 2,100 patients for 10 days) since it is still awaiting final results of large official drug trial results to be peer reviewed including the unpublished(RECOVERY-Randomised Evaluation of Covid19 Therapy) United kingdom trial.

 

 But the drug is already included in the NIH’s CoviD19 Treatment Guidelines Panel for the use of dexamethasone as a treatment for CoviD19 patients(June 25, 2020 updated).

 Dexamethasone’s side effects are… dizziness,vomiting,depression,excessive hair growth,stomach upset,insomnia,anxiety,elevated blood sugar and headache. The use of strong or potent steroids are known to cause viral replication and division in the human body and it can reactivate other diseases such as fungal,viral infections and tuberculosis. 

Dexamethasone can dampen the cytokine storm with severe and critically ill CoviD19 patients in the intensive care units but should be use with caution due to the above side effects of the drug.

 The drug should not be use in patients with mild symptoms of CoviD19. But the drug is cheap and is readily available even for under develop countries where the novel coronavirus creates enormous ill effects.

 

 

2.) Remdesivir-is an investigational broad spectrum anti-viral drug developed by Gilead and sciences Inc.intended for Ebola in 2014 but didnt worked well and was also repurposed and given an US FDA-EUA or Emergency Use Authorization as a treatment for CoviD19 patients last may 1, 2020 and showed effectiveness by shortening disease process and hospital stay of patients having severely and critically ill symptoms of Covid19 by 4 days as revealed by the ACTT or Adaptive CoviD19 Treatment trial.

 

In the new NIH treament CoviD19 guidelines updated last June 25,2020…remdesivir is given through intravenous route for five days duration in hospitalized patients with severe symptoms who needs oxygenation but not intubated and it is given for ten days duration in hospitalized patients who are on ECMO(extracorporeal membrane oxygenation) and who are also mechanically ventilated.

 As of the present time there are thirty four clinical studies under the WHO Solidarity Trial and US NIH-ClinicalTrials that are running across the globe using remdesivir in relation to patients with moderate to severe CoviD19 hospitalized patients.

 

Adaptive CoviD19 Treatment Trial-2 or ACTT-2:

Last May 8, 2020, Dr. Anthony S. Fauci Director of the US National Institute Of Allergy and Infectious Disease ( NIAID-NIH ) announced that a randomized controlled double blind clinical study will start using remdesivir an investigational broad spectrum antiviral drug develop by Gilead Sciences Inc., plus an anti-inflammatory drug baricitinib( Olumiant) an anti-rheumatoid arthritis drug by Eli Lilly and Incyte. 

The purpose of the study is to determine if remdesivir in combination with baricitinib is safe and effective as a regimen for the treatment of CoviD19 disease,likewise the study will evaluate the patients treatment outcome at day 15 and it will also important to know if the addition or combination of baricitinib with remdesivir will further decrease mortality or death in patients with CoviD19 disease.

 In ACTT-2, Remdesivir will be given  initially 200mg intravenous route then 100mg intravenously once daily thereafter to patients for ten days duration and baricitinib will be given at 4mg daily through oral route if patient is able to swallow but it will be crush and given through a nasogastric tube or NGT for fifteen days duration. Then a baricitinib placebo like tablet with inactive ingredients will also be given to the participants of the study. 

3.) Lopinavir/Ritonavir 400mg/100mg tablet (Kaletra)-ABBVIE- is an antiviral drug combination for HIV patient/s prophylaxis and treatment but is also repurposed drug for Covid19 patients. Currently there are seventy seven federally funded clinical studies that are going on worldwide related to CoviD19 disease.

The drug is given one tab twice a day for ten to fifteen days duration for adult Covid19 patients. And can be given to CoviD19 positive mature( postmenstrual age of 42 weeks)neonates more than or equal to fourteen days of aged after delivery with an adjusted dosed. 

As of the meantime,The US-NIH( National Institute of Health) treatment guidelines allowed the use of the drug for the treatment of CoviD19 patients in the clinical setting only.Other studies revealed that lopinavir plus ritonavir combination failed in many clinical trials and showed no significant efficacy when given to CoviD19 patients.

 

 

           

4.) Favipiravir and Umifenovir( Glenmark): Favipiravir is an oral antiviral drug that selectively inhibits the RNA polymerase of the virus needed for viral replication, the drug was approved for influenza treatment in Japan since 2014 and is now a repurposed drug for CoviD19 patients. 

Several investigational studies involving favipiravir are still in the process such as a phase 3 clinical trial in Japan and a phase 2 clinical trial in the US at Brigham and Womens Hospital, Massachusetts General Hospital and University of Massachusetts Medical School. 

Likewise Glenmark Pharmaceutical Company continue its  phase 3 clinical trial of using favipiravir monotherapy in moderate CoviD19 patients in India. 

Another oral antiviral drug Umifenovir used for the prophylaxis and treatment of viral influenza A and B in China and Russia, that prevents and blocks viral attachment and entry to human cells with modulatory effects to the immune system associated with increased interferon production was also tapped by Glenmark Pharmaceutical Company. 

An open label well randomized clinical trial was started in India since May 26, 2020 involving Favipiravir plus Umiferavir combination under the umbrella of Glenmark Pharmaceutical Company.

The FAITH( Favipiravir plus Umifenovir Efficacy and Safety Trial in Indian Hospital setting involving 158 patients with moderate CoviD19 disease. It has a fourteen day treatment duration of which favipiravir 1800mg/tablet will be given one tab twice a day for 14 days and Umiferavir 800mg/tablet will be given one tablet twice a day for 14 days. And patients will be evaluated for discharged if cured by having a two consecutive negative test for RT-PCR results for CoviD19.

 Aside from injectable remdesivir, Favipiravir (fabiflu) as an oral antiviral drug has been recently approved under restricted( signed consent from patients) emergency use for the treatment of mild to moderate including asymptomatic high risk CoviD19 patients in India started last June 20, 2020. Japan,Italy,Bangladesh,UAE, Russia and China are currently using the high pill burden drug with 14 day duration treatment inorder to decrease the transmission rate and viral load thus lessening patients hospitalization rate in CoviD19 patients.

 

5.) Convalescent Plasma- A clear liquid coming from donated blood of persons or patients who survived or who have recovered from CoviD19 disease. A clinical study headed by DR. Michael Joyner of the Mayo Clinic and US-FDA involving 20,000 patients received convalescent plasma transfusion starting from April 3 to june 11, 2020 and the result was promising since there was a decreased in mortality and with very minimal adverse side effect, it maybe secondary to improved patient care and convalescent plasma was immediately or readily given early before the illness progess and few patients with severe or critical symptoms was included in the study as stated by the author. But the treatment is relatively safe and cost effective. 

 

6.) Immune-Based Therapy– These drug therapies includes…

a.) intravenous immune globulins(IVIG),

b.) Immune response modulators such as Interleukin-1 inhibitors(e.g.,anakinra),Interleukin-6 inhibitors(e.g.,sarilumab,siltuzimab,tocilizumab), 

c.) Immunomodulators such as Interferons and Janus kinase inhibitors(e.g.,baricitinib) 

 

d.) Agents that target the virus -such as Convalescent plasma.

The above mentioned Immune-based drugs are all under investigational trials as of the present time and the US-NIH treatment Guidelines  as of May 12, 2020 updates don’t recommend such use in the treatment of CoviD19 patients except in the context of clinical trials. 

Several Vaccines are also under investigational and clinical study

and many are now near the final phases of their clinical trials and 

will be available before the end of this year or maybe in 2021.

 

Keep Safe……Stay Healthy and Look Cool Always!!!

Laertes B. Amihan MD

 

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