Corona: Drugs and treatment for COVID-19

Corona: Drugs and treatment for COVID-19

Research into treating COVID-19 is ongoing. There are now a few drugs that could be called “corona drugs”. The medication must have a different effect depending on the course of the disease. In severe cases, the symptomatic treatment of COVID-19 continues in the hospital. The medical staff must be prepared for possible complications to be able to intervene quickly in the event of lung failure. How is a corona infection treated, which drugs are used as part of the therapy and which are being tested?

Symptomatic therapy in mild cases

The treatment of the disease still focuses on alleviating the symptoms. This includes, for example, quenching the typically dry cough or reducing fever . Antiviral drugs should also inhibit the multiplication of the virus in the body.

 

Corona: treatment at home

If COVID-19 only manifests through mild symptoms, those affected can usually stay home and recover there in quarantine. This is often the case with the omicron variant of the coronavirus, in particular. Here, it helps you drink a lot and allow yourself enough rest. In addition, the symptoms of the disease, such as a slight fever, headache or slight cough, can be treated with suitable medicines from the medicine chest. If the symptoms worsen, such as shortness of breath, medical advice should be sought in any case.

Even if you do not have to be treated in hospital and can recover at home, you should strictly avoid contact with other people and, if possible, stay in a separate room from the other people in the household. Particular caution is required if people from risk groups live in the same household.

When in contact with other people in the household, the minimum distances should be observed, and mouth and nose protection should be worn. Regular and thorough airing is also helpful.

Otherwise, all the usual hygiene rules should be observed, such as regular hand washing or coughing and sneezing etiquette. Even if the contact persons in the household are vaccinated, an infection with the coronavirus cannot be ruled out 100 per cent, so these rules should continue to be heeded.

treatment in hospital

Depending on the severity of the symptoms, inpatient treatment in the hospital may also be indicated. In the case of complicated COVID-19 courses, the medical staff is particularly challenged to identify possible complications early and intervene in good time if necessary.

Intensive care measures, including ventilation of the sick person, can become necessary quickly, for example, if the coronavirus has infected the deep airways. In most cases, shortness of breath (dyspnea) and an increased respiratory rate lead to admission to the intensive care unit.

 

Ventilation in COVID-19

The person is considered oxygen-dependent if the oxygen content in the arterial blood is too low (hypoxemia). Oxygen is then given first, for example, via a nasal tube or oxygen mask. So-called high-flow oxygen therapy, which uses a warmed, moistened oxygen-gas mixture, is usually used.

If the affected person’s condition deteriorates, invasive ventilation may be necessary (intubation). The infected person is mechanically ventilated via a tube, i.e. a hose. This is inserted directly into the windpipe through the mouth, nose or incision. The treatment is only used in emergencies since this form of therapy represents a tremendous psychological and physical burden for those affected. There are also frequent complications, such as respiratory infections and speech or swallowing disorders.

According to the initial study results, treating non-invasively ventilated patients in prone positions should reduce the risk of subsequent intubation.

Other complications of a corona infection

In addition to the lungs, the coronavirus can also affect other organs, such as the kidneys, the nervous system, and the heart. Other possible complications include thrombosis, pulmonary embolism or inflammatory reactions involving the entire organism, which are triggered by an excessive immune response (hyperinflammation syndrome). The treatment in the hospital must then be adapted to the symptoms that occur.

Isolation and hygiene in treating people infected with coronavirus

The coronavirus pandemic poses immense challenges for the entire healthcare system. The treating staff should be specially trained for the viral disease COVID-19 and may only visit patients with multi-layer medical mouth and nose protection. Sick people are usually treated separately from other patients in the hospital. In addition, the medical and nursing staff deployed for COVID-19 should not treat patients with other diseases.

 

Approved drugs against Corona

So far, the European Commission has approved four active ingredients and two antibody preparations for treating COVID-19. All funds are used after the detection of an infection and after medical consultation. Some of the medication can be taken at home.

Remdesivir

The RNA polymerase inhibitor is an active substance initially developed for treating Ebola but has not yet been approved. Remdesivir can stop the multiplication of the coronavirus in the body by inhibiting the polymerase, i.e. an enzyme responsible for the multiplication of the SARS-CoV-2 genome. So, it has an antiviral effect.

If the virus has already spread in the body, remdesivir no longer influences the course of the disease or the mortality of those affected. According to current recommendations, the active substance should be given as soon as possible after the onset of symptoms and only used in infected people who receive artificial oxygen but do not need invasive ventilation. In this group of people, remdesivir can accelerate healing.

dexamethasone

Dexamethasone is an artificial glucocorticoid. The steroid drug does not have an antiviral effect but aims to weaken the body’s immune reactions, i.e., fight inflammatory reactions. Dexamethasone is used in oxygen-dependent infected patients whose illness has been present for more than a week. Then, dexamethasone can reduce mortality.

There is no proven benefit to using the active ingredient in an earlier phase of the disease.

 

Monoclonal antibodies (antibody drugs)

The effect of antibody drugs is based on engineered antibodies that bind to the spike protein or cytokines of the coronavirus and thus prevent it from docking to cells.

Due to this mode of action, it is assumed that monoclonal antibodies are most effective in the early phase of the disease; since then, no or only a few cells have been infected by the virus. Previous study results also indicate this. Before or during mild to moderate illness, monoclonal antibodies positively affect the risk of infection or the course of the disease.

For this reason, monoclonal antibodies have been used primarily in the early phase of infection with SARS-CoV-2 and people with an increased risk of a severe course.

Approved Antibody Drugs

In November 2021, the EU Commission approved Ronapreve ®  and the antibody-drug Regkirona ® for treating COVID-19 on the European Medicines Agency (EMA) recommendation. The latter contains the antibody regdanvimab and is administered intravenously, and Ronapreve ® is administered intravenously or as an injection. The two drugs are used in adolescents from the age of twelve (Ronapreve ® ) or in adults (Regkirona®). If oxygen has to be supplied artificially, both agents are no longer used.

In December 2021, RoActemra ® was approved by the European Commission. The drug contains the monoclonal antibody tocilizumab. This binds to the cytokine interleukin-6, which is involved in inflammatory processes in the body. RoActemra ® is already used in the European Union to treat some diseases, such as rheumatoid arthritis. It is now used in corona patients who already need artificial ventilation to reduce mortality.

 The drug Xevudy ®  has also been available in Germany since the end of January 2022. It is based on the monoclonal antibody sotrovimab. The effectiveness of the active substance is exceptionally high against the delta variant but is somewhat reduced against the omicron variant. So far, Xevudy ® has been approved for people over 12 who do not need artificial ventilation but have an increased risk of a severe course.

Corona drugs Molnupiravir and Paxl ovid ®

In October 2021, the European Medicines Agency announced that it was testing a corona drug from Merck & Co. Since January 2022, the use of molnupiravir  (trade name Lagevrio ®) has been prescribed by a doctor. This affects adult patients with an increased risk of a severe course who do not yet require oxygen therapy. In November 2021, the drug received emergency use authorization in the European Union. Molnupiravir is an antiviral medication that comes in tablet form. It is intended to prevent the viruses from penetrating body cells and preventing them from multiplying in the body. According to the manufacturers, it halves the risk of hospitalization and death for infected people. If the disease is already more advanced, the drug no longer shows any effect. A doctor prescribes Lagevrio ®, which is available in pharmacies.

In addition, the EMA recommended the use of Paxlovid ® as a corona drug in January 2022. This inhibits the multiplication of the coronavirus in the body and, like molnupiravir, can be taken orally. It can even be used at home. Paxlovid ® is available in pharmacies on prescription. So far, however, the drug has only been approved for adults with an increased risk of a severe course of COVID-19.

 

Other medications and treatment options

In addition to the active ingredients that have already been approved, a number of other drugs and therapy options are also intended to treat COVID-19. They are presented in more detail below.

Ivermectin in COVID-19?

The drug Ivermectin is used for worm diseases. In Latin America and Asia, however, it is sometimes also used as a remedy against coronavirus infections. The drug also caused a stir in the USA when numerous people used it for self-treatment – sometimes with serious health consequences.

Smaller studies have shown a link between the use of the drug and the death rate of those infected, as well as the prevention of infection with COVID-19. However, these studies had qualitative shortcomings, such as too few participants or a lack of comparisons with other therapy methods.

More comprehensive studies on the use of Ivermectin are currently pending. Until then, treatment of COVID-19 with the drug is strongly discouraged, especially since taking it incorrectly without medical advice can have serious side effects.

Passive vaccination with antibodies?

An antibody injection to prevent coronavirus infection is also currently being tested. Such a passive form of immunization could be used, for example, in people who have to take immunosuppressants and for whom the previously approved coronavirus vaccines’ effect is limited.

However, since the antibodies are gradually broken down again by the body, passive vaccinations only offer temporary protection against the coronavirus.

 

Immune serum therapy with blood plasma

Another possibility, based on a principle similar to passive vaccination, is immune serum therapy. Antibody-rich blood plasma from those affected who have already recovered is administered to COVID-19 sufferers. This blood plasma is called convalescent plasma (RKP).

The multiplication of the virus should be stopped by administering the plasma at the earliest possible stage to prevent severe courses of COVID-19.

More extensive studies are currently being conducted into the effect of convalescent plasma on COVID-19. After evaluating the first results, the World Health Organization advises against extensive use of immune serum therapy in patients with mild or moderate courses. The reason is that the treatment in these people shows no positive effects on the severity of the disease and mortality. It should only be used in studies on seriously ill people.

Drug development in progress

A variety of drugs to treat the symptoms of COVID-19 are currently in development. These drugs can be divided into five groups:

  1. Drugs to maintain lung function and regenerate the lungs
  2. Immunosuppressants, i.e. medicines that suppress the immune response (prevent hyperinflammation)
  3. Drugs to support the cardiovascular system
  4. Antiviral drugs to stop the spread of the virus in the body
  5. Active ingredients for the treatment of long-COVID

Antiviral and immunosuppressive drugs, in particular, are currently in the EMA approval process.

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