From Remdesivir to Dexamethasone, expert decodes top COVID-19 drugs

The resurgence of COVID-19 has brought all of us back to square one. Apart from dealing with stress, anxiety and panic, we are bombarded with so much information about ‘dos’ and ‘don’ts’ about COVID-19 that this overload has left many people in a dilemma. Hence, it is advisable to consult health experts rather than getting swayed by WhatsApp forwards.

Recently, Events In Mumbai, a YouTube channel posted a video where renowned pulmonologist Zarir F Udwadia spoke about treatment options for COVID-19.

According to Dr Udwadia, there are four major drugs that work quite effectively against COVID-19: Steroids, Anticoagulants, Remdesivir and Remdesivir in combination with Baricitinib. He further explained the effectiveness of these drugs, based on research reports of major studies and clinical trials of COVID-19.

Steroids

Initially, the usage of steroids against COVID-19 were barred, but now it has become an essential drug for people infected with the virus. In August last year, Head of WHO, Dr Tedros Adhanom Ghebreyesus, revealed that Dexamethasone – a steroid – has ‘life saving potential’ for critically ill COVID-19 patients. The first major breakthrough study regarding the said steroid was conducted by the Oxford University in accordance with Recovery, a study platform.

The overall results showed that Dexamethasone reduced mortality rates significantly by 35% in patients who were on ventilators, and by 20% in those who were receiving oxygen. And, since then Dexamethasone has become a standard drug in hospitals across the globe.

But, care needs to be taken while administrating Dexamethasone to patients in the early phase with mild coronavirus symptoms. It can make matters worse for such patients as it can disrupt the immune system. For patients with severe complications, not just Dexamethasone but any equivalent dose of steroid can lead to positive results.

Remdesivir

The antiviral drug, which is in high demand these days, reportedly reduces the viral load in severe COVID-19 patients. According to a study conducted by NIH (National Institutes of Health, America), during a trial when COVID-19 patients were administered Remdesivir, their recovery improved, especially in those who were under severe disease subgroup. It further showed that the ratio of largest recovery was found in those who were on oxygen. Whereas, it is less effective in those who are on ventilators. The study further claimed that Remdesivir is more effective in those who receive the drug within the first 10 days after contracting the virus.

But, unlike steroids, this drug has no statistically significant effect on mortality. It just speeds up the recovery time in Covid patients.

Medical journals like The Lancent, The New England Journal of Medicine, etc., published various studies of trials and efficacy of Remdesivir. Everything was going well for Remdesivir until Solidarity stepped in. Solidarity is an international clinical trial launched by WHO in a bid to find an effective treatment against COVID-19. It is one of the largest international, randomised trials for COVID-19 treatments, enrolling almost 12,000 patients in 500 hospital sites in over 30 countries. A global study conducted on 2,750 patients by Solidarity, which Mumbai’s renowned Hinduja Hospital was also a part of, found that Remdesivir had zero effect on 30-day mortality. After the results came out, WHO urged stoppage of Remdesivir. On the other hand, despite WHO’s warning, Remdesivir was approved by FDA in US and it became the first FDA-approved drug against COVID-19.

Remdesivir plus Baricitinib

Another breakthrough trial study, Adaptive COVID-19 Treatment Trial 2 (ACTT-2) by NIH, which included around 1,000 Covid-19 patients focussed on using Remdesivir with another drug, Baricitinib. In the trial, patients who required high flu nasal oxygen, were given Remdesivir along with Baricitinib. Surprisingly, the combo of Remdesivir and Baricitinib worked better than Remdesivir alone. But this combination may not work for mechanically ventilated patients as the trial report showed that the combination doesn’t make any difference in their recovery rate. Conclusion: this combination reduces recovery time and accelerates clinical improvement.

Anticoagulants

Anticoagulants are blood thinners, which prevent blood clotting. This is the third category of drug, which has shown promising results in COVID-19 treatment. Since Covid is said to be a respiratory disease, it attacks your lungs, and can cause blood clots in pulmonary artery vessels. Dr Udwadia suggests that Anticoagulants can be given to mild covid patients.

What doesn’t work

· Antibiotics: Azithromycin and Doxycycline

· Antivirals: Lopinavir-Ritonavir and Oseltamivir

· HCQs (Hydroxychloroquine tablets)

· Ivermectin

· Vitamins

Other potential options

Inhaled Interferon, Favipiravir and Tocilizumab are some potential drugs that may be included in Covid-19 treatment. Monoclonal antibody and Convalescent plasma therapy are other treatment options. Although, detailed reports and authentic data on the efficacy and effectiveness of these drugs are yet to be established. Therefore, usage of these drugs must be done wisely and with care.

(To watch the full video visit: https://youtu.be/DfpQOEpOmVM)

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