Coronavirus Treatment: What's in Development
Treatment for COVID-19 depends on if the case is mild or more severe. For milder cases, resting at home and taking medicine to reduce fever is often sufficient. The most severe cases require hospitalization, with treatment that might include supplemental oxygen, assisted ventilation and other measures. Two drugs may have a role for severe COVID-19 infection: the antiviral remdesivir or the corticosteroid dexamethasone.
Fighting the COVID-19 pandemic, is a top priority in medical research and pharmaceutical development. Hundreds of organizations are working on innovations to reduce the impact of the disease and prevent further infection.
What’s in the works, and when might a coronavirus treatment be ready for the general public? Paul Gisbert Auwaerter, M.B.A., M.D., an expert in infection prevention, provides an overview of what the future might hold.
Is there a coronavirus vaccine?
There is currently no vaccine to prevent infection with the new coronavirus. Vaccine development takes time. Several organizations, including Johns Hopkins, are working on a vaccine. At Johns Hopkins, investigators are working with companies to begin testing their versions in humans in summer and early fall of 2020.
Still, it could be many months of testing and refining before a COVID-19 vaccine is deemed safe, effective and ready to be administered to the general public.
The Race to Develop Vaccines for COVID-19
Can coronavirus be treated? What treatments are being tested for coronavirus?
Medications for Coronavirus
While work on the vaccines continues, pharmaceutical companies and laboratories around the world are working to develop medicines for COVID-19. Clinical trials are planned or underway to test drugs, including investigational compounds, which are already approved by the Food and Drug Administration (FDA) for other illnesses to see if one or more can have an impact on COVID-19.
Antiviral Medication and Treatment
Antiviral treatments are available to treat several diseases, such as influenza. Antiviral drugs don’t kill a virus but instead limit the production of new viruses in host cells. For most people, the best these treatments can do is shorten the duration of the illness and lessen complications. Since the coronavirus that causes COVID-19 is new, there is limited evidence regarding specific antivirals that may work against it. Doctors and scientists are looking at both existing and experimental antivirals to find effective treatments for the new disease.
One antiviral drug called remdesivir was initially developed for activity against the Ebola virus. Researchers are testing remdesivir to see how it might help patients with COVID-19, and results of some of these studies are available.
One study conducted in China did not show any benefit in treating patients with COVID-19. However, the National Institutes of Health reported that in one U.S. clinical trial (ACTT-1), remdesivir helped patients with COVID-19 recover faster when compared with patients who did not receive the drug.
Preliminary (unpublished) results show a 31% shorter recovery time in patients who were treated with remdesivir (11 days versus 15 days). In the study, patients who were able to leave the hospital or return to their normal activities were considered recovered. The patients who appeared to benefit most were those who needed supplemental oxygen but who were not so ill as to require intensive care unit stays or mechanical ventilation.
At present, remdesivir is available to patients in research trials or if they are hospitalized in institutions that have received drug under an FDA Emergency Use Authorization. The drug is an intravenous medication that can only be given to patients in a hospital setting. The course of treatment lasts 5 to 10 days.
Some organizations are exploring the possible role of monoclonal antibodies — engineered antibodies that are increasingly used in the treatment of cancer and other diseases.
Tocilizumab and sarilumab are drugs used to treat autoimmune illnesses such as rheumatoid arthritis. The trial exploring sarilumab has not shown benefit. In patients with severe COVID-19, these and similar drugs that combat inflammation are under study to see if the use of such medications may improve the intense immune reaction (also known as cytokine storm) experienced by some to the virus in later phases of illness.
Preliminary results from the RECOVERY clinical trial information shows that a steroid drug called dexamethasone reduces deaths in hospitalized patients with COVID-19. The benefit of this drug appears to be most for patients who require mechanical ventilation and to lesser degree patients who need supplemental oxygen. For patients who don’'t need oxygen and are less ill, the study showed a trend toward worse outcomes, so the drug is not meant for all hospitalized COVID-19 patients.
Dexamethasone, which has been used to treat inflammation and swelling, may be processed differently in Black people. Johns Hopkins researchers note that this difference, along with other considerations, means more research on this drug will be helpful to more solidly confirm its role as a safe, effective treatment for COVID-19.
Chloroquine and Hydroxychloroquine
These compounds have been used for decades to prevent malaria and to treat some autoimmune disorders such as lupus. On June 15, 2020, the Food and Drug Administration (FDA) revoked its authorization to use hydroxychloroquine to treat COVID-19, based on a large, scientific study that showed no benefit to patients who were treated with this drug. The FDA reports that use of hydroxychloroquine is associated with serious heart rhythm problems and other safety issues. Other studies worldwide have halted their clinical trials with these drugs for COVID-19.
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Convalescent Blood Plasma Therapy
When people become infected and ill from a particular virus and then get better (convalesce), their immune system has successfully produced antibodies to fight that virus. Doctors have used forms of antibody therapy for over a hundred years in medical treatment.
Researchers at Johns Hopkins and other institutions are exploring whether using antibodies from people who had COVID-19 and recovered could protect those not yet infected.
The Johns Hopkins team, led by Arturo Casadevall, M.D., Ph.D., an expert in molecular microbiology and immunology and infectious diseases, is collecting antibodies from the blood plasma of people who have recovered from COVID-19. Plasma is the clear, straw-colored fluid portion of the blood that carries blood cells, platelets and proteins, including antibodies.
The researchers hope there is a way to use these antibodies so that, when introduced into another person’s bloodstream, they can bind to the new coronavirus and destroy it. The team published its proposal in the March 13, 2020, issue of The Journal of Clinical Investigation.
In some hospitals, doctors are using convalescent blood plasma therapy to treat patients who have COVID-19 and are at a high risk for serious illness or death. The benefit of the treatment is not yet proven.
What you need to know from Johns Hopkins Medicine.