Medicine/Drugs research for Covid-19 (Coronavirus) patients

drugs to treat COVID 19 patients

WARNING: Below information is just to let you know about the treatments which are under research. Don’t take any medicine without consulting doctors.

COVID-19 ( Coronavisus disease 2019) is an epidemic disease. This disease was first recognized in December 2019 in Wuhan, the capital of China’s Hubei province. The three patients were admitted to the hospital with pneumonia connected to the cluster of acute respiratory illness. But later this infection spread to several people spontaneously.  Now the disease is transmitted almost 70 countries globally within less period and creating a serious issue. Due to this disease death rates are increasing globally day by day.

The infected person gets symptoms such as fever, cough, shortness of breath, muscle pain, sputum production, diarrhea, sore throat, abdominal pain and last but not least deterioration of smell or taste. But in the majority of cases, the infected person gets mild symptoms and progress to pneumonia and multi-organ failure.

We all know that this is an epidemic disease and mainly it spreads by blob produced during cough, sneezing of an infected person. It will happen in 2 ways i.e., direct contact by an infected person within one meter moreover, the infected person should close his face while coughing and sneezing. And one more way is indirect contact, ie the blob survives on the surface of cloths for many hours. Hence, touching any such infected surface or cloth and then touching one’s mouth, nose or eyes can transmit the disease. The incubation period of COVID 19 (time between getting the infection and showing symptoms) is 1 to 14 days. Some people with the infection, but without any serious symptoms can also spread the disease.

As it comes to treatment still research is going on by the experts to treat Covid-19 patients. However few drugs are using by the doctors. But few of the drugs are already approved for treating other diseases such as Malaria, HIV, and arthritis.

  1. Chloroquine: It is an antimalarial drug and synthetic version of quinine. It is a natural compound found in the bark of cinchona trees. This drug helps in the slow down of virus entry and reduces the replication of the virus. Chloroquine has in vitro activity against SARS-CoV-2 and may have immunomodulating properties. Mechanisms may include inhibition of viral enzymes or processes such as viral DNA and RNA polymerase, viral protein glycosylation, virus assembly, new virus particle transport, and virus release. Other mechanisms may also involve ACE2 cellular receptor inhibition, acidification at the surface of the cell membrane inhibiting fusion of the virus, and immunomodulation of cytokine release. As it comes to evidence, preclinical data in vitro suggest has activity against SARS-CoV-2. Few reports also have proof that the potential benefit in inhibiting the bad situation of pneumonia patients with SARS-Cov-2 infection but also there is specific data. This drug is using to treat the patients based on the symptoms but there is no specific drug to treat Covid-19 patients hence this drug is bounded with some risk factors such as cardiac arrhythmias, retinal damage due to long term usage and also for diabetic patients.
  • Hydroxychloroquine: It is almost related to chloroquine. It is considered as a less toxic metabolite of the malaria drug. It is used to treat certain autoimmune diseases such as lupus and rheumatoid arthritis. It is one of the oldest drugs and is used from the 1950s.  It works by disrupting the communication between cells and the immune system. It has a vitro activity against SAR-CoV-2 and has the special property of immunomodulating. It includes mechanisms such as the hindrance of viral enzymes and also polymerase the viral DNA and RNA.   Other mechanisms may also involve ACE2 cellular receptor inhibition, acidification at the surface of the cell membrane inhibiting fusion of the virus, and immunomodulation of cytokine release. Research suggests that hydroxychloroquine might more potent than chloroquine because this drug exhibit a higher in vitro antiviral effect as compared to chloroquine when the drug was added before the viral challenge.  The EC50 values for chloroquine were greater than 100 microM at 24 hours and 18.01 microM at 48 hours whereas the EC50 values for hydroxychloroquine were 6.25 microM at 24 hours and 5.85 microM at 48 hours. As it comes to the risk factor, before medicating the patients the doctors should be more conscious of cardiac arrhythmias, Risk of retinal damage, especially with long term use o Caution in patients with G6PD deficiency and also Cautious in diabetics patients.
  • Kaletra: It is a combination of 2 antiviral drugs. Lopinavir and ritonavir are drugs used to combat HIV. These drugs are widely available and clinical research is still going on. These drugs are a compliment to each other. Lopinavir prevents viral enzymes from cutting up important proteins and these are key to HIV’s reproduction whereas ritonavir helps to boost lopinavir concentrations in cells. But some recent studies suggested that there are no benefits for patients with severe cases with Covid-19.
  • Remdesivir: It was an Investigational Nucleoside Analogue.  It was developed to fight Ebola and failed to prove its effects. But few researchers showed some positive results against both MERS and SERS. Those are caused by Coronavirus. Hence it may have some positive effect against Covid-19 still it is unclear but recent studies show that it appears to block RNA replication during the reproductive cycle of coronavirus. Remdesivir is a monophosphoramidate prodrug of remdesivirtriphosphate (RDV-TP), an adenosine analog that acts as an inhibitor of RNA-dependent RNA polymerases (RdRps). Remdesivir-TP competes with adenosine-triphosphate for incorporation into nascent viral RNA chains. Once incorporated into the viral RNA at position i RDV-TP terminates RNA synthesis at position i+3. Because RDV-TP does not cause immediate chain termination the drug appears to evade proofreading by viral exoribonuclease.
  • Favipiravir: It is a flu drug developed in Japan. It has shown promising results in treating mild to moderate cases of Covid-19. It is an antiviral drug used to treat influenza in Japan. It was also approved in the last month as an experimental treatment for the Covid-19 infected patients. In contrast,  many influenza antivirals that target proteins on the surface of the virus, like Roche’s Tamiflu, favipiravir targets the viral RNA polymerase, making it a potential treatment for Covid-19 if the SARS-CoV-2 RNA polymerase is similar enough to the influenza polymerase. In the clinical research, conducted by the National Clinical Research Center for Infectious Diseases in Shenzhen, two 1,600mg doses of favipiravir on the first day and two doses of 600mg for the following 13 days given to the infected patients, in addition to interferon-alpha aerosol inhalation (five million units twice daily), led to faster viral clearance than the lopinavir/ritonavir group, with a median of 4 days versus 11 days, respectively, as well as improvement in chest imaging.
  • Actemra: It is an immunosuppressant drug that is used to silent cytokine storms. It is approved to treat rheumatoid arthritis and juvenile rheumatoid arthritis. It blocks a cell receptor that binds interlukin-6, a type of protein released by the immune system that can trigger dangerous inflammatory cascades. It is already approved in China to Covid-19 patients. The research on Actemra’s use in COVID-19 is based on the hope that the drug could interrupt the process of ‘cytokine release syndrome’ (CRS), a form of the serious inflammatory response that can occur as difficulties of some infections.
  • Azithromycin: It is a macrolide antibacterial drug and may prevent bacterial superinfection and macrolides may have immunomodulatory properties to work as an adjunct therapy and has a special property in pulmonary inflammatory disorders. They may downright inflammatory responses and decrease the excessive cytokine production associated with respiratory viral infections; however, their direct effects on viral clearance are uncertain. Azithromycin was administered in combination with hydroxychloroquine to prevent bacterial superinfection and approved by Government also. There is a risk factor for cardiac arrhythmias patients for prolonged consumption of this drug.

 Above are the drugs used by the drugs to treat COVID-19 patients. Currently, the research and clinical trials are going on and no specific medication recommended to treat COVID-19. If any symptoms are faced by the patients it is better to contact the doctor immediately. It is not recommended for self-medication and also the infected person should avoid public gathering. 

An investigational vaccine is designed to protect against COVID-19 and asses as a Phase-1 has started at Kaiser Permanente Washington Health Research Institute (KPWHRI) in Seattle. The National Institute of Allergy and Infectious Diseases (NIAID), part of the National Institutes of Health, is raised funding the trial. KPWHRI is part of NIAID’s Infectious Diseases Clinical Research Consortium. The open-label trial will register 45 healthy adult volunteers ages 18 to 55 years over approximately 6 weeks. The first participant received the investigational vaccine. The study is varifying different doses of the experimental vaccine for safety and its ability to induce an immune response in participants. This is the first of different strides in the clinical preliminary procedure for assessing the potential advantage of the antibody.

The two companies that are Singapore based Sensing Self Ltd and China’s Wondfo have cleared the National Institute of Virology (NIV) sanctioned for the rapid antibody test kit for COVID-19. The decision finalize after the Indian Council of Medical Research (ICMR) decided to start antibody tests to check whether an individual was previously infected with the SARS-Cov2 virus before. This is done to understand the epidemiology of the disease. Similarly, so many institutes such as ROCHE Pharma, Pfizer pharmaceuticals and many more institutes are doing research and clinical trials to develop vaccine/ drugs for COVID-19.

Sources:
https://www.mohfw.gov.in/pdf/PreventionandManagementofCOVID19FLWEnglish.pdf
https://www.who.int/emergencies/diseases/novel-coronavirus-2019/technical-guidance
https://www.elsevier.com/__data/assets/pdf_file/0007/988648/COVID-19-Drug-Therapy_Mar-2020.pdf