Coronavirus treatments: new studies on hydroxychloroquine and remdesivir

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Two new reports on the treatment of coronaviruses offer new perspectives on the experimental drugs tried to treat Covid-19.

The former raises cautious optimism about Gilead Sciences’ experimental remdesivir, while the latter raises questions about the safety of hydroxychloroquine, President Donald Trump has recklessly hypothesized as a potential remedy for the coronavirus.

Here’s what the studies have revealed and what they can tell us about potential treatments for the deadly disease.

Remdesivir

Biotechnology company Gilead Sciences has published an analysis in the New England Medical Journal On Friday, follow-up responses from 53 patients with severe Covid-19 cases to compassionate remdesivir therapy – that is, patients received the drug unapproved because no other option is available available.

According to the report, doctors observed clinical improvement in 36 of 53 patients; 8 worsened and 7 died. Doctors were able to remove 17 of the 30 patients who were on life support devices that help people breathe out of the machines.

The study authors note that the death rate of patients they observed – 13% – is lower than the death rate of 17 to 78% in China in people seriously ill with Covid-19. Side effects included diarrhea, rash, kidney failure and hypotension.

There are huge limits to the conclusions that can be drawn from this analysis. There was no randomized control group, which would allow the authors to compare the performance of patients who received placebo versus those who received remdesivir. And the total number of patients in the United States, Canada, Europe and Japan is very small.

However, the study authors and external experts described the results as reason for hope.

“We cannot draw definitive conclusions from these data, but the observations of this group of hospital patients who received remdesivir are optimistic,” said Jonathan Grein, lead author of the analysis and director of hospital epidemiology at Cedars-Sinai Medical Center in Los Angeles, in a statement from Gilead. “We are eagerly awaiting the results of controlled clinical trials to potentially validate these results.”

“The results are indeed encouraging and promising from this uncontrolled remdesivir intervention study,” tweeted Eric Feigl-Ding, epidemiologist and health economist at Harvard T. H. Chan School of Public Health. “TESTS TESTS TESTS PLEASE,” he added.

Paul Goepfert, an infectious disease specialist at the University of Alabama in Birmingham, told the Washington Post: “It’s still a promising drug, but it definitely doesn’t prove anything. He added, “The main thing you can learn from this study is that it does not cause any untoward damage. “

Daniel O’Day, President and CEO of Gilead, said that much study is needed to understand if and how remdesivir could treat Covid-19.

“When studying remdesivir, the question is not only whether it is safe and effective against COVID-19, but in which patients it has activity, how long should they receive treatment and what stage of their illness would treatment be most beneficial, ”he said. Friday, in an open letter on the new report. “Many answers are needed, which is why we need several types of studies involving many types of patients.”

Hydroxychloroquine

On a less optimistic note, the French drug safety agency has published data indicating that hydroxychloroquine, the antimalarial drug that Trump has pushed as a potential miracle drug for the treatment of Covid-19, appears to have serious side effects on the heart when used for Covid -19 patients and should be used under medical supervision. The report details 43 cases of “cardiac incidents” related to hydroxychloroquine.

“This initial assessment shows that the risks, particularly cardiovascular, associated with these treatments are very present and potentially increased in COVID-19 patients. Almost all of the reports come from health facilities, “the agency said, according to the Hill newspaper. “These drugs should only be used in hospitals, under close medical supervision.”

The report does not offer definitive evidence on the safety of the use of hydroxychloroquine, but it highlights how dangerous it is for non-experts – like the president – to enthusiastically present it as a promising remedy when ‘There is no definitive proof that it works or is safe to use.

Trump encouraged the public to use it, but only with the approval of a doctor, in combination with the antibiotic azithromycin – asking “What do you have to lose?” At press conferences when he has discussed it as treatment he is looking forward to. But scientists and health care professionals have advised against considering it an effective treatment.

This is partly because, as reported by Nicole Narea of ​​Vox, the drug has serious side effects, and its benefits for Covid-19 patients are not yet proven:

[S]Scientists have known for decades that the drug causes unwanted psychiatric side effects and can also lead to life-threatening heart complications. Only clinical trials can clarify who would benefit and who would be at too great a risk.

Prescribing the drug is now “a sort of” last resort “measure for people with serious illness,” Joshua Michaud, deputy director for global health policy at the Kaiser Family Foundation, told Vox, adding: “I would be more concerned to have a large number of people, including those who have no symptoms or only mild symptoms, take this medication because of the risk of negative side effects and uncertain benefits at this stage. “

There is no clinically proven treatment for Covid-19 yet. As scary as waiting during an economically destructive global pandemic, more research is needed to find firmer answers.


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