Intensive research is being carried out on drugs against Covid-19 / other than dexamethasone, doctors still have little control over them.
– RSPEAK_START -> Research into drugs against the coronavirus is in full swing. Drugs against severe disease are another building block in combating the corona pandemic – in addition to the demonstrably very effective vaccinations. This could also protect people who have not or could not yet receive a vaccination, or who became infected despite being vaccinated.
is still missing
There is still no drug approved for all patients that specifically fights the coronavirus. Instead, doctors use tried and tested drugs that help with certain complications, depending on the course of the Covid 19 disease. Often, patients in the hospital are given blood thinners – because Covid-19 increases the risk of thrombosis, heart attacks and strokes. In addition, antibiotics are said to protect against additional bacterial infections. But specifically against the Sars-CoV-2 virus, these are ineffective.
The difficulty lies in the biology of the virus, writes the Berlin molecular biologist Emanuel Wyler in a guest article for the Berliner Zeitung. With Corona there are initially no symptoms after infection. “When, among other things, a cough or sore throat set in, the immune system has in most cases already started fighting the virus,” says the researcher from the Max Delbrck Center for Molecular Medicine. “As with the flu, drugs that target the virus often come too late.”
The only approved agent
is considered obsolete
Remdesivir (with the trade name Veklury), a product of the US company Gilead, is the only agent to have received approval in the EU in July. But only for certain Covid-19 patients: namely those with pneumonia who receive additional oxygen but do not yet need invasive ventilation. The drug originally developed against Ebola is supposed to prevent Sars-CoV-2 from multiplying in the cells. But meanwhile the World Health Organization (WHO) speaks out against a treatment.
In its statement from mid-September, the Federal Joint Committee of Doctors, Clinics and Health Insurance Funds sees only a minor benefit of remdesivir in moderately ill patients and none at all in severely ill patients. The virologist Christian Drosten from the Berlin Charit also said in the NDR Corona podcast at the end of September: Initially, high hopes were placed in Remdesivir, but things have now changed.
Dexamethasone is said to
Suppress the immune response
In Germany, dexamethasone has long been used as a drug against Covid-19 in inpatient corona therapy, even without general official EU approval. It has been used to treat autoimmune diseases for decades. Molecular biologist Wyler calls it a “central drug for the treatment of Covid-19”.
The anti-inflammatory and cortisone-containing agent is intended to slow down an excessive immune reaction in corona patients in the intensive care unit, which often occurs with Covid-19. According to the Robert Koch Institute (RKI), the greatest benefit has been demonstrated in invasively ventilated patients. There mortality could be reduced somewhat. For people with less severe Covid disease, on the other hand, use could “even be disadvantageous,” according to the RKI. Bacterial and fungal infections can occur in immune system dampers.
Hope rests on
Eight drugs for Covid therapy are at various stages in the approval process at the EU drug authority EMA – including antibody preparations that are already in use in Germany for mild disease.
In special cases, a combination of the monoclonal antibodies casirivimab and imdevimab (trade name Regn-CoV2) from Regeneron and Roche is already used. This cocktail is the first drug that the WHO recommends for the prevention of severe disease in patients with mild symptoms but with risk factors.
Monoclonal antibodies are produced in the laboratory and are intended to put the virus out of action or, in some cases, to slow down the patient’s excessive immune system. Antibodies from the blood plasma of recovered corona patients can serve as a model. Monoclonal means that the antibodies used are all the same and attach to the virus or to a cell at a fixed point. Another four drugs in this group that are currently being investigated, which are quite expensive, are the combination of bamlanivimab and etesevimab from Eli Lilly, regdanvimab (Regkirona) from Celltrion, sotrovimab from GSK / Vir Biotechnology and tocilizumab (Roactemra) from Roche.
Charit chief virologist Drosten explains in the NDR that the administration of monoclonal antibodies is “almost always too late” – namely when the virus has already multiplied strongly in the body. In an average patient, this is essentially the case at the time the symptoms start.
Further resources are available
in the starting blocks
In tests with the antibody cocktail AZD7442 (other name: Evusheld) from Astrazeneca, a clinical study showed that the risk of symptomatic Covid-19 disease could be reduced by 77 percent with the combination. On October 14th, the EMA began an approval test. In addition, the EMA is also investigating the immune system-suppressing agents anakinra (trade name Kineret) and baricitinib (Olumiant), both of which are already approved for other diseases such as rheumatoid arthritis.
The pill Molnupiravir originally developed against the flu by the US company Merck has recently made headlines, which, like remdesivir, is supposed to reduce the spread of the coronavirus in the body cells. According to a clinical study, it reduces the likelihood of very severe disease. Compared to the placebo group, only half as many of the patients who received the drug had to be hospitalized or died with mild to moderate symptoms. Merck aims to submit marketing authorization applications worldwide as quickly as possible.
No benefit from ivermectin
The use of the anti-wormer drug ivermectin is controversial. After reports of alleged successes with Covid treatment, the shelves have been bought empty in some countries – but a comprehensive analysis of more than a dozen clinical studies has recently shown no evidence of effectiveness. The RKI warns of severe side effects and recommends use “only in the context of controlled clinical studies”. The malaria drugs hydroxychloroquine and chloroquine also turned out to be ineffective. Here, too, the RKI discourages use outside of controlled studies.
Funding from the federal government
In September, Federal Research Minister Anja Karliczek and Health Minister Jens Spahn announced that the federal government would support six projects by companies that have dedicated themselves to the development of Covid drugs – with a total of 150 million euros. One of the recipients is not a classic company, but the DRK Baden-Wrttemberg-Hessen. The blood donation service had already carried out the “Capsid” study in collaboration with 13 clinical centers, including the Freiburg University Hospital, which was recently published in the Journal of Clinical Investigation. It examined whether the blood plasma of Covid-19 recovered people can improve the chances of recovery if it is administered to patients with a severe course of Covid-19. The conclusion of the study resulted in the recommendation that this so-called convalescent plasma should be given as high a dose as possible and given early in the course of the disease, summarized Eberhard Weck, press spokesman for the German Red Cross on request. The new project that has now been funded follows on from the Capsid study. The aim is to examine the effectiveness of an early transfusion with convalescent plasma with high antibody concentrations in vulnerable patients. Covid-19 convalescents can donate to the institutes of the DRK blood donation service, says Eberhard Weck. Other projects that are to be funded according to the federal press release are located at the companies AdrenoMed AG, Apogenix AG, Atriva Therapeutics GmbH, CORAT Therapeutics GmbH and InflaRX GmbH. According to the Ministry of Research, the projects are pursuing different therapeutic strategies to improve the chances of recovery. These included anti-inflammatory approaches or direct antiviral therapy. However, the plans are still being examined and therefore no further details can be given, says on request. After all, the DRK received its funding decision last week.