SINCE the first case of COVID-19 was officially reported by the local authority in Wuhan, China, on December 31, 2019, followed by the WHO declaration of this pandemic, medical centers around the world struggled to search for effective treatments, including vitamin-mineral supplements. No herbals have been found effective against this SARS-CoV2 virus.
The following March 17, 2021 report by Ryan Basen and Amanda D’Ambrosio of MedPage shows which treatments are in and which ones are out:
Treatments currently in use
Remdesivir
Remdesivir, an antiviral, is currently the only FDA-approved therapy for COVID-19. It prevents SARS-CoV-2 from replicating by binding to RNA-dependent RNA polymerase, a key enzyme the virus needs to propagate. Authorization (EUA) has been revised to also allow for treatment of hospitalized pediatric patients under 12 who weigh at least 7.7 lbs.
NIH guidelines recommend the use of remdesivir in hospitalized patients who require supplemental oxygen, either on its own, or in combination with dexamethasone. For those requiring high-flow or noninvasive ventilation, NIH recommends remdesivir only in combination with dexamethasone. Its scope was limited in December due to “lack of data showing benefit at this advanced stage of the disease.”
Dexamethasone
Dexamethasone, a corticosteroid with potent anti-inflammatory effects, is ecommended for use in many categories of patients hospitalized with COVID-19, but not for those with mild-to-moderate disease who aren’t in the hospital.
While it recommends against dexamethasone for those hospitalized but not on supplemental oxygen, NIH recommends it for those who need supplemental oxygen, high-flow or noninvasive ventilation, and mechanical ventilation or ECMO.
The use of dexamethasone in those who required mechanical ventilation cut the risk of death by about 35% compared with usual care. Overall mortality also was lower in all hospitalized patients who received the drug.
Tocilizumab
On March 5, the NIH updated its guidance regarding the anti-interleukin-6 (IL-6) monoclonal antibody tocilizumab for COVID-19. It now recommends using tocilizumab in combination with dexamethasone in certain hospitalized COVID patients exhibiting rapid respiratory decompensation. That includes those who have been admitted to the ICU within the previous 24 hours who require invasive mechanical ventilation, noninvasive mechanical ventilation or high-flow nasal cannula oxygen, or – outside the ICU – patients with rapidly increasing oxygen needs who require noninvasive ventilation or high-flow oxygen and have significantly increased markers of inflammation.
The agency says tocilizumab should be avoided for “significantly” immunocompromised patients. There’s no evidence for using other IL-6 inhibitors in COVID-19.
Anticoagulation
The US-NIH recommends that all adults (including pregnant patients) hospitalized for COVID-19 who aren’t pregnant should receive prophylactic anticoagulation to prevent venous thromboembolism (VTE).
Convalescent Plasma
Convalescent plasma has an FDA emergency use authorization to treat hospitalized COVID-19 patients. Only high-titer plasma is now authorized. However, NIH guidelines state there are insufficient data to recommend for or against the use of convalescent plasma in the treatment of COVID-19.
Monoclonal Antibodies (one of the treatments President Trump had): Eli Lilly’s bamlanivimab, bamlanivimab/etesevimab combo and Regeneron’s casirivimab/imdevimab
Despite the FDA authorizations, NIH doesn’t recommend the therapies in its COVID-19 treatment guidelines. “There are currently insufficient data to recommend either for or against the use of bamlanivimab or the casirivimab plus imdevimab combination for the treatment of outpatients with mild to moderate COVID-19,” according to an NIH statement.
One barrier to practical application is that they require intravenous infusion – most easily delivered in hospitals yet hospitalized patients aren’t eligible for them.
Failed or debated therapies
Hydroxychloroquine
Both the WHO and the NIH recommend against the use of hydroxychloroquine – with or without azithromycin – for the treatment of COVID-19 in both hospitalized and non-hospitalized patients. This was a spectacular failure in efficacy of this hyped-up anti-malarial drug.
Findings from the RECOVERY trial showed that use of hydroxychloroquine did not reduce mortality among COVID-19 patients after 28 days, and in fact trended towards risk of death. Additionally, patients who received the antimalarial drug had a longer median hospital stay than those who received standard of care.
Another clinical trial based in Brazil found that hydroxychloroquine with or without azithromycin did not improve outcomes for hospitalized patients with mild-to-moderate COVID-19 after 15 days.
Ivermectin
In January, the NIH changed its recommendation from “against” use of ivermectin in COVID-19 to noting that there are “insufficient data” to recommend for or against the therapy.
The antiparasitic drug has shown some potential to inhibit SARS-CoV-2 replication in cell cultures. However, according to the NIH, achieving the plasma concentrations necessary to achieve the antiviral efficacy detected in vitro would require doses up to 100-fold higher than those approved for use in humans.
Vitamin C
NIH states that there are insufficient data to recommend for or against the use of vitamin C (ascorbic acid) in COVID-19. A randomized controlled trial of vitamin C and zinc showed no impact of either supplement on the course of symptoms in patients with mild illness.
Vitamin D
NIH states that there are insufficient data to recommend for or against the use of vitamin D in COVID-19.
In February, a large randomized Brazilian trial published in JAMA found no difference in length of hospital stay for those with moderate to severe COVID-19 given high-dose vitamin D or placebo.
Zinc
NIH states there are insufficient data to recommend for or against the use of zinc in COVID-19. It also recommends against zinc supplementation above the recommended dietary allowance for the prevention of COVID-19, except in a clinical trial.
Protease Inhibitors
The NIH recommends against using lopinavir/ritonavir and other HIV protease inhibitors to treat COVID-19 in hospitalized and non-hospitalized patients because clinical trials have not shown clinical benefit in COVID patients.
Colchicine
Neither the NIH nor WHO have any guidelines concerning this oral anti-inflammatory drug often used to treat gout. The colchicine arm of the RECOVERY trial was recently halted because an independent data monitoring committee found the drug wasn’t helping hospitalized patients with COVID. However, top-line results from the COLCORONA trial announced in January showed improved outcomes for patients with mild illness from COVID-19.
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The opinions, beliefs and viewpoints expressed by the author do not necessarily reflect the opinions, beliefs and viewpoints of the Asian Journal, its management, editorial board and staff.
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The main objective of this column is to educate and inspire people live a healthier lifestyle to prevent illnesses and disabilities and achieve a happier and more productive life. Any diagnosis, recommendation or treatment in our article are general medical information and not intended to be applicable or appropriate for anyone. This column is not a substitute for your physician, who knows your condition well and who is your best ally when it comes to your health.
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Philip S. Chua, MD, FACS, FPCS, a Cardiac Surgeon Emeritus based in Northwest Indiana and Las Vegas, Nevada, is an international medical lecturer/author, a Health Public Advocate, and Chairman of the Filipino United Network-USA, a 501(c)3 humanitarian and anti-graft foundation in the United States. Visit our websites: philipSchua.com and FUN8888.com Email: [email protected]
