COVID-19 Rx: In or out

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    ‘Remdesivir, an antiviral, is currently the only FDA-approved therapy for COVID-19. It prevents SARS-CoV-2 from replicating…’

    SINCE the first case of COVID-19 was officially reported in Wuhan, China on December 31, 2019, followed by the WHO declaration of a pandemic, medical centers around the world have struggled to search for effective treatments, including vitamin-mineral supplements.

    No herbals have been found effective against this SARS-CoV2 virus.

    The following March 17, 2021 report by Ryan Basen and Amanda D’Ambrosio of MedPage shows which treatments are in and which ones are out:

    Treatments currently in Use ‘Remdesivir’

    Remdesivir, an antiviral, is currently the only FDA-approved therapy for COVID-19. It prevents SARS-CoV-2 from replicating by binding to RNA-dependent RNA polymerase, a key enzyme the virus needs to propagate. Authorization (EUA) has been revised to also allow for treatment of hospitalized pediatric patients under 12 who weigh at least 7.7 lbs.

    NIH guidelines recommend the use of remdesivir in hospitalized patients who require supplemental oxygen, either on its own, or in combination with dexamethasone. For those requiring high-flow or noninvasive ventilation, NIH recommends remdesivir only in combination with dexamethasone. It scope was limited in December due to “lack of data showing benefit at this advanced stage of the disease.”

    Dexamethasone

    Dexamethasone, a corticosteroid with potent anti-inflammatory effects, is recommended for use in many categories of patients hospitalized with COVID-19, but not for those with mild-to-moderate disease who aren’t in the hospital.

    While it recommends against dexamethasone for those hospitalized but not on supplemental oxygen, NIH recommends it for those who need supplemental oxygen, high-flow or noninvasive ventilation, and mechanical ventilation or ECMO.

    The use of dexamethasonein those who required mechanical ventilation cut the risk of death by about 35% compared with usual care. Overall mortality also was lower in all hospitalized patients who received the drug.

    Tocilizumab

    On March 5, the NIH updated its guidance regarding the anti-interleukin-6 (IL-6) monoclonal antibody tocilizumab for COVID-19. It now recommends using tocilizumab in combination with dexamethasone in certain hospitalized COVID patients exhibiting rapid respiratory decompensation. That includes those who have been admitted to the ICU within the previous 24 hours who require invasive mechanical ventilation, noninvasive mechanical ventilation or high-flow nasal cannula oxygen, or — outside the ICU — patients with rapidly increasing oxygen needs who require noninvasive ventilation or high-flow oxygen and have significantly increased markers of inflammation.

    The agency says tocilizumab should be avoided for “significantly” immunocompromised patients. There’s no evidence for using other IL-6 inhibitors in COVID-19.

    Failed or Debated Therapies Hydroxychloroquine

    Both the WHO and the NIH recommend against the use of hydroxychloroquine — with or without azithromycin — for the treatment of COVID-19 in both hospitalized and nonhospitalized patients. This was a spectacular failure in efficacy of this hyped-up anti-malarial drug.

    Findings from the RECOVERY trial showed that use of hydroxychloroquine did not reduce mortality among COVID-19 patients after 28 days, and in fact trended towards risk of death. Additionally, patients who received the antimalarial drug had a longer median hospital stay than those who received standard of care.

    Another clinical trial based in Brazil found that hydroxychloroquine with or without azithromycin did not improve outcomes for hospitalized patients with mild-to-moderate COVID-19 after 15 days.

    Ivermectin

    In January, the NIH changed its recommendation from “against” use of ivermectin in COVID-19 to noting that there are “insufficient data” to recommend for or against the therapy.

    The antiparasitic drug has shown some potential to inhibit SARS-CoV-2 replication in cell cultures. However, according to the NIH, achieving the plasma concentrations necessary to achieve the antiviral efficacy detected in vitro would require doses up to 100-fold higher than those approved for use in humans.

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    Philip S. Chua, MD, FACS, FPCS, a Cardiac Surgeon Emeritus based in Northwest Indiana and Las Vegas, Nevada, is an international medical lecturer/author, a Health Advocate, and Chairman of the Filipino United Network-USA, a 501(c) 3 humanitarian foundation in the United States. Websites: philipSchua.com and FUN8888.com Email: scalpelpen@gmail.com