Therapies for COVID-19

blue and silver stetoscope

George Delgado, MD

As we navigate the third wave of the endless COVID-19 pandemic it is good to pause and review the current available treatments for the illness since vaccinating most of the country will take another five months. See my recent article on the current vaccines.

Many different medications have shown some promise in treating COVID-19 either in the laboratory or in patients. Hydroxychloroquine and chloroquine were early crowd favorites. There were anecdotal reports of great promise and a (then) unpublished, uncontrolled study by Dr. Vladimir Zelenko in New York that looked very promising. A group associated with the prestigious Henry Ford Medical Center published an uncontrolled hospital study that showed benefit. After several very well designed, controlled studies showed no benefit, the reasonable conclusion is that hydroxychloriquine and chloroquine do not have any role in the prevention and treatment of COVID-19.

Ivermectin is another medication that has received considerable attention. Laboratory studies show that it can stop the replication of coronaviruses. Three or more well designed studies have demonstrated effectiveness. These studies are from Egypt and Pakistan. Another study is being conducted in Colombia. There are several others in the pipeline. For now, until more studies are released, I think that this safe medication can be used for prevention after exposure or for treatment early in the course of illness.

Monoclonal antibodies are antibodies designed to neutralize the coronavirus. US Food and Drug Administration (FDA ) has give emergency use authorization for two monoclonal products, one called bamlanivimab from Lily and the two antibody product containing casirivimab and imdevimab from Regeneron. They are approved for high-risk outpatients (not hospitalized patients) who are not requiring supplemental oxygen. This treatment requires coordination with an infusion center or hospital for the single intravenous infusion treatment.

For hospitalized patients, the approved and effective treatments include oxygen, dexamethasone and remdesivir. Dexamethasone is a potent corticosteroid (“steroid”) that calms the inflammation and may prevent the dreaded cytokine storm that makes some COVID-19 patients so critically ill. Remdesivir is an anti-viral drug that was initially developed to treat the Ebola virus. It turns out it has modest activity against SARS-CoV-2, the virus that causes COVID-19.