Saturday, October 16

Innovative drugs that could change the course of Covid | Coronavirus


It remains one of the most successful outcomes in the battle against Covid-19. An inexpensive treatment for inflammation was found to save the lives of seriously ill patients, while a trio of highly touted therapies were shown to have no effect.

It is now estimated that the discovery of the efficacy of the drug dexamethasone has saved around 650,000 lives worldwide, according to Professor Martin Landray, founder of the Recovery program, the world’s largest randomized Covid-19 drug trial, which revealed the existence of the drug. anti-Covid properties last summer. “In the UK alone, dexamethasone has already prevented more than 12,000 deaths,” he told the Observer.

The breakthrough demonstrates the power of large-scale randomized trials to identify effective drugs and will follow, in the coming weeks, with the results of another handful of promising treatments that are being studied as part of the recovery program.

These drugs, which could be crucial in the fight to contain Covid-19 next year, are: convalescent plasma, taken from recovering Covid patients; monoclonal antibodies, made by Regeneron, that were used to treat Donald Trump; two anti-inflammatory drugs, tocilizumab and colchicine; and aspirin. All are undergoing trials carried out by thousands of doctors and nurses on tens of thousands of patients in Britain’s hospitals. The first results are expected in January or early February.

Recovery It was created by Landray and Peter Horby at the beginning of the Covid-19 pandemic. The two Oxford scientists realized that doctors would soon seek treatments once cases started arriving in hospitals, but they would need a clinical trial to find which ones were effective. It took them nine days from writing their first protocol to enrolling their first patient, a process that normally takes nine months. Since then, one in 10 hospitalized Covid patients has entered the trial.

Martin Landray
Martin Landray says that large-scale trials can show who will benefit the most. Photograph: HDRUK

And those numbers have been crucial to success, Landray added. Comparing 100 people who receive a drug to 100 who do not receive it can produce highly variable results. However, by randomizing thousands of patients to contrasting treatments, robust responses are obtained.

“You find out which ones really work,” Landray said. “Also, we can find out which patients will benefit the most. Will it be the old or the young or the immunosuppressed? You can only find out if you have a test with thousands of people. “

So far, Recovery, short for Randomized Evaluation of Covid-19 Therapy, has ruled on four drugs: azithromycin, an antibiotic; the combination of drugs lopinavir-ritonavir; hydroxychloroquine, a treatment for malaria and rheumatic diseases; and dexamethasone. Only the latter saved lives or helped to recover.

A hit rate of just one in four may seem like a poor value. However, the extraordinary number of lives saved thanks to dexamethasone demonstrates the value of the Recovery program, the world’s largest randomized Covid-19 drug trial. The program also ensured that time and money were not wasted on drugs that did not help patients.

And that will become an increasingly important issue, Landray said. “When we started Recovery, we looked for cheap, widely available but promising drugs, and we found that one of them, dexamethasone, worked. But the drugs we are considering now will cost hundreds of pounds per treatment, so we have to really be sure they work before we roll them out on a large scale, “said Landray.

Having thousands of people with complications from Covid-19 is a grim reality in the UK today, but that high number at least makes large-scale trials possible.

However, there is a limit to what doctors and nurses can be expected to do, Lanray added.

“We designed this study to be as simple to implement as possible so as not to overwhelm the busy NHS front-line staff. The support from them and from the patients has been remarkable. Our results have improved Covid care for millions. The answers we get early next year, whatever they are, will do it again. “

In the pipe

Convalescent blood plasma It is taken from those recovering from Covid-19 and has antibodies that can help others fight infections. Widely used in the United States, although scientists don’t yet know if it works or who would benefit the most from it. The recovery program should have answers in a few weeks.

Monoclonal antibodies They are artificial antibodies manufactured by the American biotech company Regeneron and were used to treat Donald Trump. It is not yet clear at what stage of the disease they should be administered.

Tocilizumab is an anti-inflammatory arthritis drug that is believed to show great promise, although its exact benefits are unknown. It is also expensive.

Colchicine it is another promising anti-inflammatory drug; it is often used to treat gout.

Aspirin is an anticoagulant agent that could help reduce blood clots in the lungs, a worrisome complication in some cases of Covid-19.


www.theguardian.com

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