Volume 7 • 2020 • Issue 7

Antiviral drugs target the mechanism of the virus itself. •  Remdesivir is a broad-spectrum antiviral drug developed during an Ebola outbreak. It causes inhibition of RNA polymerase, an important enzyme in viral replication. Its efficacy in treating COVID-19 has had conflicting results. Despite this, the U.S. Food and Drug Administration (FDA) has approved Remdesivir as an emergency therapy for hospitalized COVID-19 patients. •  Ribavarin is an RNA polymerase inhibitor. Studies testing its efficacy in treating COVID-19 are conflicting. There is a suggestion that combining Ribavarin with Interferon may be beneficial. •  Kaletra is a combination antiviral (containing Lopinavir and Ritonavir) that is used to manage HIV-positive patients. Lopinavir inhibits HIV proteases, an enzyme required for viral assembly. Due to its poor bioavailability and extensive biotransformation, it’s administered with Ritonavir. In a 2020 randomized control trial, no benefit was observed in COVID-19 patients receiving this combination therapy vs. standard care. However, other studies have shown some benefit when Kaletra is administered in combination with Interferon. •  Favipiravir is an RNA polymerase inhibitor developed in Japan and it’s approved in some countries for the treatment of Ebola, influenza and norovirus. Preliminary clinical results show significant improvement in respiratory health (as determined by chest x-rays) in COVID-19 patients compared with the Lopinavir/ Ritonavir combination. Studies also show a reduction in respiratory symptoms, faster viral clearance, and fewer adverse events. Unfortunately, it is not effective in critically ill COVID-19 patients. •  Chloroquine and Hydroxychloroquine are indicated for treatment of inflammatory disease, such as rheumatoid arthritis and lupus, and in the treatment of malaria. Despite positive claims of the effectiveness of chloroquine and hydroxychloroquine, most clinical trials have shown that they are not effective in the treatment of COVID-19. Due to the risk of cardiac complications, the FDA has issued a safety warning in relation to the use of chloroquine and hydroxychloroquine in the treatment of COVID-19. •  Arbidol is approved for prophylaxis and treatment of influenza A and influenza B in Russia and China. It has been demonstrating good results in vitro. A study shows that SARS-CoV-2 virus was undetectable in 95%of patients taking Arbidol for 14 days as compared with 50% of patients in the control group. Immunomodulators alter and suppress the immune system response. •  Actemra is a monoclonal antibody. Although there is no data to recommend Actemra, some experts have suggested it may be helpful. •  Interferons are a group of signaling proteins made and released by host cells in response to the presence of viruses. In a typical scenario, a virus-infected cell will release interferons causing nearby cells to heighten their anti-viral defenses. Interferon beta-1a and interferon beta-1b are used to treat and control multiple sclerosis, an autoimmune disorder. Using interferons, in conjunction with other therapies to treat COVID-19, seems somewhat promising. •  Azithromycin is a macrolide-type antibiotic. Some studies of its efficacy in treating COVID-19 have been inconclusive. Other studies show that azithromycin combined with hydroxychloroquine may be of some benefit. Corticosteroids lower inflammation in the body and reduce immune system activity. •  Corticosteroids are widely used to treat severe pneumonia and prevent lung damage because they can suppress systemic inflammation. It seems that they may be effective as an adjunct to COVID-19 treatment. Low- dose corticosteroids may be therapeutic in patients with severe symptoms. To watch the full interview with Dr. Ouanounou, visit CDA Oasis at: bit.ly/35gx52q S upporting Y our P ractice 33 Issue 7 | 2020 |