Covid 19 - Current Status (Corona Virus)

In the beginning of the pandemic, certain medications that were designed and approved for other diseases were studied and tested as treatments for the treatment of COVID in certain patients. They are therefore referred to as Repurposed COVID medicines. More research and studies are needed and ongoing to verify the efficacy of a number of the medications that are listed below, for the different aspects of COVID treatment. Later, there were medicines specifically developed for COVID.

All of these medications can cause negative side effects that should be monitored clinically, particularly when they are administered in combination or to patients who have already existing medical conditions. Thus, these medications should be administered in the appropriate manner as an element in COVID treatment, based on the type of patient, the severity of the disease, and the presence of any associated co-morbidities. The most important thing is that all of these medicines should be used without the approval and supervision of a licensed doctor. Additionally, none of these medicines are supported by studies on the efficacy of the latest Omicron variant.

Anti-VIRAL DRUGS

They prevent the spread of the virus within the host cell. They can be used only within the first few days following the onset of the disease and its symptoms and only in specific cases.

Remdesivir

The drug (originally created for the Ebola virus) administered via intravenous injection (infusion) is now approved to treat all COVID patients in hospitals. The drug targets RdRp, the enzyme (RNA-dependent polymerase) necessary for viral replication.

The huge SOLIDARITY study conducted by WHO found no evidence of a significant impact of the drug redeliver in reducing mortality as well as the time it takes to initiate ventilation and the length of stay for hospitalized patients. However, the lower ATC1 trial demonstrated an overall reduction in the recovery time and mortality for the patients who are receiving oxygen therapy. It has been approved by authorities such as the USFDA, EU, and DCGI-India.

Remdesivir Remdesivir is helpful for patients who are hospitalized due to breathlessness, lower oxygen saturation levels that require oxygen therapy, or acute lung inflammation and pneumonia. It is recommended to start it within the first few days after symptoms (maximum in the first 10 days) and is usually not very effective in patients who are typically hospitalized within two weeks (inflammatory stage) in the course of the disease.

A study conducted recently (PINETREE) has proven that a 3-day course of the drug remdesivir administered in the initial week of illness in an outpatient infusion clinic or OPD at home or in a home injection could lead to an 87% lower chance of death or hospitalization in patients at risk of death with multiple comorbidities.

Favipiravir

This medication (originally an anti-flu medicine) is taken orally and is approved in a few countries such as India and the EU for patients with mild-moderate COVID and those living at health centers or at home. The drug also targets the RdRp enzyme.

Clinical studies have shown that the favipiravir has been shown to reduce the length of recovery time as well as faster pain relief, in addition to greater speedy clearance of the virus and less shed. It’s not yet determined whether Favipiravir affects the course of the disease and whether it is able to lower the risk of hospitalization, complications, the need to receive oxygen therapy, or the transmission within the community and in the family. It can be used in the first five days after the onset of symptoms but is not needed in the majority of cases.

Molnupiravir

It is a different antiviral medication that was developed. It works by preventing the replication of specific RNA viruses, such as SARS-CoV-2, by increasing the number of mutations that occur within the viral RNA replication through the RNA-directed RNA polymerase enzyme.

Molnupiravir can be been proven in clinical studies that can reduce hospitalization rates by about 30% in patients suffering from COVID who receive it within 3-7 days after onset of symptoms. It was approved by the USFDA in December 2021 to treat moderate-to-moderate COVID for those who are aged 18 or older and who are not vaccinated or are at a high risk of progressing to severe COVID which could lead to death or hospitalization, and for whom other approved treatment options for COVID aren’t accessible or clinically acceptable.

It was also granted approval for emergency use through authorities such as the European Medicines Agency (EMA) as well as also by the Drug Controller General of India (DCGI). There is however concern regarding the potential adverse effects that are closely monitored by all regulators.

Paxlovid (nirmatrelvir-PF-07321332 with ritonavir)

The drug was recently made available and is the very first oral antiviral treatment for COVID that was approved by USFDA in the month of December 2021. It does this through binding and blocking the SARS-CoV-2 virus’s primary protease enzyme (Mopar) and thereby hindering the spread of the virus.

Paxlovid was been shown in clinical studies to decrease hospitalization rates dramatically by around 90% in patients suffering from COVID in the first three days of the onset of symptoms.

Paxlovid is approved by the USFDA for moderate-to-moderate COVID among individuals aged 12 years and over who are at risk or at risk of developing severe COVID that could result in the need for hospitalization or even death. It is targeted specifically at those who are not vaccinated and/or with risk factors or other comorbidities. It is also approved through the European Medicines Agency (EMA).

anti-HIV medications

The drugs like lopinavir-ritonavir were initially tried but with limited success in some countries where the drugs were not yet widely available. They might be helpful in patients with a lymphocyte count that is low. However, this combo is not proven effective for COVID patients in hospitals in accordance with the WHO SOLIDARITY drug trial.

Other anti-HIV medicines such as zidovudine are still being tested for COVID. Studies are waiting to be completed. At present, the anti-HIV drugs aren’t included in COVID treatment guidelines.

2-deoxy-D-glucose (2-DG)

It was which was approved and developed in India in the 2nd wave between April and May 2021 following the small phase 3 clinical trial that showed an improvement in the oxygen requirement or dependence, as well as speedier recovery. The drug comes available in the form of a powder sachet that can be taken orally after the dissolution in water.

It is a specific way of building up in the cells infected by the virus, stopping the growth of the virus and energy production. It could be a beneficial adjunct for moderate to severe COVID patients who are hospitalized due to poor oxygen saturation. However, more information is needed from larger, controlled studies that are randomized.

Nitric Oxide Nasal Spray (NONS)

NONS was recently introduced in a few countries, including India. The nasal spray has demonstrated effectiveness in reducing significantly the amount of COVID and its severity in the phase 2 and 3 tests. It works by creating a physiochemical barrier within the nasal passages and airways through its viral (virus kill) effects.

Other sprays for the mouth and nose are being developed, which contain active ingredients and excipients that are derived from foods that mimic the action of soap (fatty acids that have the action of detergent). These sprays are capable of breaking down enveloped viruses as well as pathogens such as coronaviruses, influenza, and variants. Clinical and research data are in the pipeline.

Interferons

They signal antiviral proteins that are part of the immune system. PEG Interferon-alpha-2binjection has been recently approved in nations like India to treat moderate COVID to lower viral burden and enhance recovery.

Some preliminary data has been uncovered from interferon beta treatment in exhalation form to help prevent severe lung damage and disease from occurring in COVID patients, however, definitive studies are still to be conducted.

ANTIPARASITIC DRUGS

Ivermectin

It was recommended (sometimes together in conjunction with antibiotic Doxycycline) in moderate-to-mild COVID that are not hospitalized. Ivermectin has been believed for its antiviral effects and in some clinical studies, it was found to be more effective in reducing recuperation time, more effective symptom relief, and a better course of treatment.

Ivermectin has also demonstrated efficacy as a drug for prophylaxis for patients who have documented exposure to COVID in a study. The results of large clinical trials haven’t confirmed the definitive role of Ivermectin in the treatment of COVID. But, ivermectin is extremely cost-effective and was an integral part of the treatment plans advocated by medical associations in certain nations like India during the period of 2020-21 but not later.

Another drug to combat parasites, Nitazoxanide is also being researched however no definitive data have been discovered as of yet.

Hydroxychloroquine

It is an oral anti-malaria and anti-rheumatoid arthritis (RA) drug that has been utilized in a few countries. It is being studied in isolation as well as in conjunction in conjunction with one of the anti-inflammatory drugs azithromycin. Initial results were positive in a few clinical studies that demonstrated a reduction in the amount of viral shedding and hospitalization rates, ICU admission, and death when it was administered earlier in the course of patients with mild-moderate COVID who are not hospitalized. However, subsequent studies have disproved the same. Hydroxychloroquine is not proven to be beneficial in extreme cases or in hospitalized patients, according to research conducted under the WHO SOLIDARITY and other recent studies.

Awareness and monitoring using ECG (for QT interval lengthening or abnormalities in the heart rhythm) are recommended, especially in COVID patients who are older and suffer from other health problems that are co-morbid, and when they are treated with antibiotics, such as azithromycinHydroxychloroquine is still a part of COVID treatment protocols in mild cases that are not hospitalized in some countries because its low cost.

Hydroxychloroquine is also approved in a handful of countries such as India to treat serious or symptomatic COVID among exposed health care professionals and their close/household contacts, but definitive evidence from science is not available for this.

Antibiotics

Antibiotics aren’t recommended routinely in COVID patients unless there is a reason to believe that there is a secondary bacterial infection present, which can cause sore throats, pain after swallowing, or cough.

Azithromycin can be used in these situations, however, it should not be without discernment. There is no established use or clinical indication for the use of Doxycycline.

Sometimes, antibiotics are also administered to patients admitted to hospitals to help prevent infection with bacteria when they are on immune-suppressive medication.

Anti-inflammatory DRUGS

Corticosteroids

They comprise prednisolone, dexamethasone, and methylprednisolone(oral/injectable). Corticosteroids have been proven effective in clinical trials to reduce the severity of inflammatory lung disease and death in hospitalized moderate-severe COVID patients, particularly those who are who require oxygen therapy.

At present the only corticosteroids that have been proved to be effective in critically or severely hospitalized COVID-19 patients. Corticosteroids should not ever be administered to patients with mild COVID who are not hospitalized within the first week of illness, especially when their oxygen saturation is adequate while their markers of inflammation are in good condition. They could be given later in the second week the event that cough or fever becomes persisting or recurs and inflammatory markers such as CRP are markedly elevated or increasing and oxygen saturation is declining below 94 percent. In these cases they are administered in the form of tablets with low doses or, more often, to be used Inhalers ( budesonide).

Injecting steroids into patients who have mild symptoms and maintaining oxygen saturation could cause worse harm than benefit, and therefore the right dosage, as well as the timing for these medications, is essential. High-dose and prolonged use of steroids is connected with a reduction in immune function as well as a rise in blood sugar and the possibility of Mucormycosis.

Baricitinib

It is an oral anti-arthritic medicine that is often employed as an anti-inflammatory drug (usually together with the drug remdesivir) for COVID hospital-based treatment in particular for people who are not responsive to or cannot be treated with corticosteroids, or who have a very low number of lymphocytes.

Recently, this drug was acknowledged by WHO as a treatment for COVID patients as an addition to steroids, and also as a safe and oral alternative prior to starting tocilizumab or tocilizumab.

Cytokine-inhibitors

Tocilizumab can be an injectable anti-RA drug (anti-IL-6 cytokine) It is recommended in patients admitted to hospitals for the purpose of reducing the severe damage to the lung and the symptoms due to a ‘cytokine-related storm’ (a damaging hyper-immune reaction that causes massive inflammation and rapid rise of inflammation markers).

Sarilumab an anti-RA anti-IL-6 drug has also been approved for this purpose. patients admitted into ICU who have not shown improvement over the next 24 hours, despite corticosteroids or nasal oxygen with high flow, could be patients for these medicines.

Itolizumab An injectable anti-psoriasis medicine was also granted approval for limited use in COVID-related cases.

Due to the scarcity of these medications Certain hospitals are making use of other alternatives such as bevacizumab or bevacizumab, etc. However, both approvals from regulatory authorities and clinical evidence are not available. Active infections should be eliminated prior to using these medications, and as they are powerful immunosuppressants, they should be constant monitoring for any adverse reactions.

Cytokine absorption filters ( cytosol) are available as kits for hospital use during cytokine storms. These filters help remove inflammatory mediators from the blood of the patient that has been pumped out following which the blood is returned to the person.

Ulinastatin

It injection-able anti-inflammatory (protease inhibitor) drug that is used to treat pancreatitis and sepsis that reduces the inflammatory marker and other cytokines. It can be administered typically in conjunction with corticosteroids, in COVID patients in hospitals with advancing damaged lungs, such as ARDS, or in a cytokine storm to lessen the risk of complications, require for mechanical ventilation, and the risk of death.

Methylene blue

It is administered via a nebulizer, either as sublingual tablets or injections. It has also demonstrated some positive effects in temporarily improving oxygen saturation as well as reducing inflammation factors that are involved in a cytokine-related storm, however, large-scale studies are required to confirm its effectiveness as well as its role in the treatment and its benefits.

Colchicine

The oral form of the drug that has provided evidence of reducing hospitalization, and mortality, as well as the necessity for ventilation in the early stages following COVID treatment, is hospitalized but not, RT-PCR positive patients. (recent COLCORONA study).

It could be a good alternative to corticosteroids in moderately to moderately COVID patients with additional risk factors such as diabetes or high BP or heart disease, obesity, or a history of respiratory diseases, particularly when they are suffering from an elevated fever (>101 degrees F) as well as low levels of lymphocytes. But, more research is required to establish a clear function. Colchicine has not been proven to be beneficial for COVID patients who are hospitalized.

Vitamin C

Vitamin C is a well-known antioxidant that has shown some case-based and anecdotal evidence that it can reduce massive inflammation throughout the body, particularly during a “cytokine storm” in certain patients in hospitals. COVID patient, when administered injections in extremely large doses.

Anti-Clotting MedICINES

Aspirin(used at very early doses in mild to moderate cases) may have protective effects on the epithelium due to its anti-inflammatory and antiplatelet (anti-thrombotic) actions. Aspirin is recommended to be used for patients who are already taking it to treat coronary disease and risk factors.

low molecular weight Heparins (LMWH)are anticoagulant medications such as enoxaparin. They can be administered subcutaneously, and are used in patients admitted to hospitals with an increased chance of thrombosis..

Anticoagulants that act directly in the oral cavity such as the apixaban and Rivaroxaban are prescribed to patients who have been discharged from hospitals or, in rare cases, for patients with a high D-dimer, which suggests the risk of thrombosis.

Anticoagulants should never be used regularly or with a wide range of frequency in patients who are not hospitalized or have mild to moderate home care needs. Another drug under investigation, nafamostat, also an anticoagulant, is currently in the study for its antiviral capabilities of blocking entry and activation of the SARS-CoV-2 in human cells.

Statin group consisting of cholesterol-lowering medicines (like atorvastatin) are also antithrombotic and anti-inflammatory properties that can protect blood vessels and reduce the damage to endothelial cells and their dysfunction. At the present, the drugs are recommended to be used in patients who are already taking them to control cholesterol and heart disease. The drug is being assessed for the potential advantages as an adjunct treatment for COVID patients.

A BODY TREATMENT

Biology

In November 2020, biological monoclonal antibody drugs casirivimab-imdevimab and bamlanivimab-etesevimab (as combinations) and in May 2021, another one sotrovimab have been approved by the US FDA for treating mild-moderate COVID patients 12 years or older at high risk for progressing to severe COVID, complications, and hospitalization. This includes patients aged 65 or older. old or older or older or suffer from certain concomitant medical conditions, such as hypertension, diabetes kidney disease, heart diseases, respiratory ailments, and overweight (BMI of 35 or greater) and immunosuppressive disorders/therapies.

The agents are administered in a single intravenous injection and are specifically formulated to fight the spike protein from the coronavirus, which blocks its infiltration into human cells. The best results are administered within 72 hours of the symptom’s first onset (maximum within one week). These agents should not be administered to hospitalized patients or those who require oxygen therapy or ventilatory support.

Of these, Sotrovimabhas some action against Omicron however it is currently under further research and study and isn’t as of yet accessible in India.

Convalescent Plasma

Convalescent Plasma is the non-cellular component in the blood of recovered patients that is a source of antibodies against COVID. COVID virus. It is utilized to treat some severely and non-responsive hospitalized patients and has contributed to the recovery of certain patients. But, at present, clinical studies aren’t able to prove its effectiveness or its advantages, and further studies are needed before it is approved for use.

Plasma therapy is typically beneficial in the case of high antibody titers and given earlier in the course of the disease. Its efficacy and adequacy on a large scale remain elusive.

IVIg (Intravenous Immunoglobulin)

It is also utilized in severely ill patients who are not responding to other treatments and medications in some COVID hospitals. While some studies have revealed improvements in the clinical outcome and decreased mortality, more research is needed to determine the time and the type of patients that could benefit. It is possible for managing post-COVID multisystem inflammatory syndrome (MIS).

Preformed COVID antibody concentrated ( hyper-immune globulin) is also being developed to treat and prevent short-term disease however, more evidence on a large-scale scale is still needed on the efficacy of these treatments.

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