Drug combination therapies showing promise in COVID-19 treatment

Medical Watch

Some good and bad news today on the medication front.

The nation’s top health officials announced the worldwide Remdesivir trial is showing a 31% faster recovery time for patients taking the anti-viral drug. But officials admit this is only a modest improvement and not fulfilling the hopes for widespread treatment.

So doctors are turning to combination therapies, including drugs used to treat the virus that causes AIDS.

The triple lineup — Lopinavir/Ritonavir and Ribavirin — used in combination with Interferon Beta1, appear to reduce the length of COVID-19 infection.

Dr. Frank Palella is a professor of medicine and division of infectious diseases at Northwestern University.

“It’s not unusual for viral infections to use multiple medications simultaneously and there are different reasons that sometimes this works,” he said. “One of the reasons can be that the different components. The different drugs work at different parts of the virus or at different phases of the virus is lifecycle, different points in this medication.”

With that in mind doctors in Hong Kong gave the triple threat to 86 patients with mild to moderate COVID-19 from February to late March. 41 patients got a single drug Lipinovir/Ritonivir. The researchers found the triple-antiviral therapy combination was safe and superior to the single drug therapy, alleviating symptoms, cutting hospital stays in half and shortening virus shedding.  

“The wisdom behind wanting to reduce the amount of time that someone is shedding virus of the viruses detectable, has implications for that infected a person because it’s a proxy for the fact that the virus cannot make more of itself and initiate trigger S cascade about events including the life-threatening inflammation,” Palella said. “Also, the shorter the duration of time and individual sheds the virus the least likely that they are capable of transmitting the virus to someone else.”

And the spread of COVID-19 is so dangerous because some people deteriorate rapidly.

“So we don’t know exactly why certain people develop these more profound inflammatory, life-threatening reactions to a viral infection like Kobe,” Pallella said. “But we do know that sometimes using as part of the treatment, not just a drug which inhibits the virus, but tamping down the inflammatory reaction to the body can be a positive thing.”

Side effects were mild including nausea which resolved in a few days. And the drug combination did not over activate the immune system in what’s called a “cytokine storm,” frequently seen in patients with severe COVID-19. Like with most anti-viral drugs, these together worked better when given in the first week of symptoms.

“All viruses really seek to find ways to survive, to reproduce themselves to replicate,” Pallella said. “In that respect. it is true of all infections. There are a finite number of ways that viruses can reproduce themselves. So that drugs that have been fond effective against one virus, not uncommonly can impact the aspect of another virus which utilizes a similar way of reproducing itself.”

The triple combination appears not just to reduce the risk for death but also the need for mechanical ventilation. Now the researchers want to test the combination in a larger, placebo-controlled study and in patients with more severe illness.

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