All the drugs and anti Covid treatments that really work

Not just vaccines. In addition to the most effective weapon to fight Covid-19, the scientific community has sought and found drugs to prevent contagion but also to treat the infection. From monoclonal antibodies to home care, after the necessary experimentation to evaluate their safety, quality and efficacy, specific therapies and medicines have been approved by the competent health authorities of the drug, the European Ema and the Italian Aifa. Anti Covid treatments are a delicate issue, above all because they are often exploited by those who have no vax positions and want to diminish the fundamental role of vaccines, proposing fake news on pseudo-therapies not authorized by the competent bodies, with the concrete risk of creating damage for the patients.

Vaccines aside, the hope remains to find adequate treatment especially for those who unfortunately still need hospitalization. This is why Ema and Aifa have drawn up specific dossiers on curative drugs against coronavirus, dividing them into “certified”, “under review” and “not certified” or “harmful”. Let’s see what are the anti-Covid drugs and extra vaccine treatments that really work, according to science.

Home care and hospital care

There are currently two lines of therapy to treat Covid infections: at home or in the hospital. Home care is reserved for patients who do not require oxygen therapy, which can only be administered in the hospital after hospitalization. At home, the patient’s vital signs and clinical condition can be monitored, for example by measuring oxygen saturation. The drugs that can be administered during home care are acetaminophen or non-steroidal anti-inflammatory drugs (so-called NSAIDs).

In case of hospitalization or admission to a specialized center, on the other hand, in addition to oxygen therapy, monoclonal antibodies, corticosteroids (or cortisone, anti-inflammatory drugs) and heparin (an anticoagulant, injectable active ingredient capable of slowing down or interrupting the process of blood clotting, preventing thrombosis that affects some patients). All must be administered under strict medical supervision. None of them will save the world from Covid, but at the right doses and for the right patients they can help treat the disease, according to experts.

Monoclonal antibodies – drugs directed specifically against the virus – are administered in the early stages of the disease, intravenously, and are particularly indicated for patients at risk of severe forms (heart disease, diabetes, hypertension or frail subjects in general). Currently, the monoclonal antibodies that have received the green light from AIFA are the mix bamlanivimab and etesevimab (Eli-Lilly), casirivimab and imdevimab (Regeneron / Roche) and sotrovimab from GlaxoSmithKline. On 11 November, the European Medicines Agency (EMA) also expressed a positive opinion on two additional treatments: Ronapreve (casirivimab / imdevimab) and Regkirona (regdanvimab), identified as promising therapies under the EU strategy on fight against Covid-19. Both are treatments to be used during the early stages of infection and based on antiviral monoclonal antibodies. These are proteins designed to lock onto a specific target, in this case the Sars-CoV-2 virus spike protein, which the virus uses to enter human cells.

Merck’s anti Covid pill

And we come to the first pill indicated for the treatment of Covid, registered at the beginning of October 2021 by the giant Merck Sharp & Dohme in partnership with Ridgeback Biotherapeutics. This is the antiviral molnupiravir, the so-called “Merck pill”, to be taken orally. The company has applied for emergency clearance in the United States and “marketing to other regulatory agencies worldwide.” How does it work? According to the phase 3 clinical study, the drug, if administered in the early stages of infection, would halve the risk of hospitalizations and deaths in adult patients at risk and with mild or moderate Covid-19.

The drug is taken for five days, four tablets a day, without the need for hospitalization or administration under medical supervision. It appears to be very effective when given in the early stages of the infection, within five days of the onset of symptoms. On November 4, the UK drug agency (MHRA) approved molnupiravir. It can be prescribed to those who are positive for Covid and have at least one risk factor linked to a possible serious contagion. In Italy, the coordinator of the Technical Scientific Committee Franco Locatelli announced that “the dossier was requested by Aifa to have this weapon also available with the doses of molnupiravir”. In the face of the increase in infections in the European Union, the European Medicines Agency is ready to speed up the procedures for the green light.

Off-label drugs and plasma therapy

In these months of the pandemic, the Italian Drug Agency has approved several clinical trials to verify the effectiveness of so-called off-label drugs, that is, already used for other diseases, including to combat Covid-19. To provide updated information on the drugs used, Aifa has created a site with updated cards to make explicit the therapeutic guidelines within which it is possible to foresee a controlled and safe use of the drugs. To date, there have been 71 clinical trials on anti Covid drugs in Italy. Among these drugs are tocilizumab, hydroxychloroquine, colchicine, azithromycin, ivermectin and plasma therapy, based on the collection of antibodies from convalescent patients. Not all, however, have given the desired results.

Convalescent plasma therapy in patients who developed Covid did not give the expected outcomes, according to a clinical study called “Tsunami”, promoted by ISS and AIFA and coordinated by the Higher Institute of Health. The study compared the effect of convalescent plasma with high titer of neutralizing antibodies, associated with standard therapy, compared to standard therapy alone in patients with Covid-19 and pneumonia with mild to moderate ventilatory impairment. 27 clinical centers distributed throughout the country participated in the study, with 487 patients involved. Demographics, existing comorbidities, and concomitant therapies were similar in the two patient groups, 241 assigned to plasma and standard therapy and 246 to standard therapy alone. Overall, there was no evidence of a plasma benefit in terms of reducing the risk of respiratory worsening or death in the first thirty days.

Tocilizumab, on the other hand, is a drug traditionally used for arthritis and is effective against Covid. It can be used for hospitalized patients with rapidly deteriorating clinical conditions. Its use is justified by the ability to block the production of interleukin-6, preventing the effects of the activation of the “inflammatory cascade” caused by Covid, as we have explained here. Today this drug is much more than an encouraging therapy being tested, so much so that the World Health Organization has recommended it for seriously ill patients (along with Sarilumab, also used for the treatment of rheumatoid arthritis). These are the first medicines to be effective against covid, after the corticosteroids (or cortisone, anti-inflammatory drugs) recommended by the WHO last September. The “Toci” has positive effects on the serious respiratory consequences that some of those who contract the coronavirus have and works by blocking the excessive immune reaction that often develops in patients. There are 15 fewer deaths per thousand patients and 23 fewer intubated patients, according to the results of twenty-seven clinical trials.

Useless or not recommended drugs

Remdesivir, on the other hand, is the first antiviral drug to have obtained authorization from the EMA for the treatment of Covid. In the light of recent studies, it can only be used in selected cases as the data do not agree or demonstrate a clear benefit, and in any case only in a hospital setting. A separate chapter is that of drugs that are not recommended or useless. Aifa does not recommend the use of the antirheumatic drug hydroxychloroquine in patients with Covid, nor does it consider it useful to authorize new clinical trials in hospitalized patients. The scientific evidence that has accumulated in the therapeutic use of hydroxychloroquine demonstrates “the complete lack of efficacy and, on the other hand, an increase in adverse and therefore harmful cases”.

Other studies have shown instead that some drugs are not useful against Covid. This is the case with anti-HIV, colchicine and ivermectin (a pesticide). In the United States, these drugs have poisoned various patients who have used them without medical advice. Parvulan, an acne treatment drug registered in Brazil, not authorized in Italy, is also not recommended due to its uselessness. The use of vitamin D, lactoferrin, quercetin and other food supplements is not recommended due to therapeutic ineffectiveness.

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