DRUGS USED FOR COVID-19

Remdesivir.
It’s an antiviral from the U.S. Company Gilead, studied for Ebola, showing to be able in vitro to hinder the activity of coronaviruses.
A multicenter study of 1062 adult patients hospitalized for Covid-19 with pneumonia randomly assigned 541 of them to the Redemsvir treatment, while 521 were assigned to treatment with placebo.
Patients treated with Remdesivir had an average recovery time of 10 days (compared to 15 days for patients on placebo) and a mortality rate amounting to 11.4% on day 29 of hospitalization, compared to the 15.2% for the placebo group. This shows a slight efficacy of Remdesevir in shortening recovery times, but mortality does not show statistically significant differences.
Beigel JH, et al. Remdesivir for the Treatment of Covid-19 – Final Report. N Engl J Med 2020 Nov 5;383(19):1813-1826. doi: 10.1056/NEJMoa2007764. Epub 2020 Oct 8.

Lopinavir / ritonavir combination (trade name Kaletra).
An antiviral used successfully in the treatment of AIDS. In a study involving 199 patients hospitalized for Covid-19 pneumonia, 99 were assigned to the Lopinavir / Ritonavir treatment, and 100 to a standard treatment. Both recovery times from pneumonia and mortality at day 28 of hospitalization did not show statistically significant differences between the two groups of patients.
Cao B, et al. A Trial of Lopinavir-Ritonavir in Adults Hospitalized with Severe Covid-19. N Engl J Med. 2020 May 7;382(19):1787-1799. doi: 10.1056/NEJMoa2001282. Epub 2020 Mar 18.

Favipiravir (trade name: Avigan).  
There are only inconclusive studies results, because of the inherent small dimensions. This antiviral, produced by a Japanese company related to the Fujifilm Group, is used in case of severe flu, thanks to its ability to block viral replication. Avigan suddenly became famous thanks to a video shot in Tokyo and posted online by a Roman pharmacist: you could see people walking around without masks, and without any fear of contagion, according to him because protected from taking this drug.

Chloroquine / Hydroxychloroquine.
Chloroquine was introduced into clinical practice as a prophylactic treatment of malaria in 1947. Hydroxychloroquine is a molecule derived from chloroquine, with fewer side effects and, in some cases, more effective ones. Due to their anti-inflammatory properties they’re also used for the treatment of rheumatoid arthritis and lupus erythematosus. Both have antiviral activity “in vitro” against SARS-Cov-2, but probably to obtain this efficacy “in vivo” (in humans) it is necessary to use high – and therefore toxic – dosages.
The trials on Covid-19 have not yielded convincing results.

Tocilizumab.
It is an antibody that blocks cytokine interleukin-6, used for the treatment of rheumatoid arthritis. It was therefore tested in Covid-19 to fight the “cytokine storm” which is involved in the development of the hyper-inflammatory phase of the disease. A study conducted in Italy was early stopped, due to a lack of results. There are over 50 cytokines, that’s why it is illusory to expect results by blocking just one.

Heparin.
Positive results were only to be found in patients with intravascular coagulation, disseminated by septicemia, while mortality at 28 days was not changed by the use of Heparin.
Tang N, et al. Anticoagulant treatment is associated with decreased mortality in severe coronavirus disease 2019 patients with coagulopathy. J Thromb Haemost. 2020.
It should be remembered that, when blood vessels are damaged, the use of anticoagulants is able to reduce the thrombotic risk, but at the same time it conveys in increasing the risk of bleeding, especially in the brain.

Cortisone.
In a group of 2104 patients hospitalized for Covid-19, mortality was observed at 28 days from hospitalization of 22.9%, for those treated with dexamethasone and 25.7% for those following a standard therapy. This is therefore a very modest result.
Recovery collaborative group. Horby P, et al. Dexamethasone in Hospitalized Patients with Covid-19 – Preliminary Report. N Engl J Med 2020 Jul 17;NEJMoa2021436. doi: 10.1056/NEJMoa2021436. Online ahead of print.