What is the most effective drug

Has there been a drug against the new coronavirus for a long time?

Perhaps no new drug against the novel coronavirus SARS CoV-2 has to be found at all. Existing active ingredients may also help against the COVID-19 pathogen.

The advantage of the "repurposing" procedure is obvious, because repurposing drugs that have already been approved or developed is not only cheaper, but above all much faster because the lengthy clinical test phases can be shortened.

Whichever active ingredient or which drug is most sensibly used against the new coronavirus in the end: First, the necessary tests and decisions by the drug authorities must be awaited.

All experts urgently warn of possible side effects, especially in the case of self-medication without consulting a doctor!

Three different drug groups

Three drug groups in particular are being examined for their effectiveness against the new SARS-CoV-2 coronavirus:

Antiviral drugs should block the replication of viruses or prevent them from entering lung cells. Antiviral drugs have been developed, for example, against the normal influenza flu, against hepatitis C, but also against HIV, Ebola and above all against the two diseases SARS and MERS, which are also caused by coronaviruses. Well-known anti-malarial drugs, whose effectiveness against viruses was only recently discovered, were also tested.

Immunomodulators should limit the defense reactions of the body so that the immune system does not overreact and also cause life-threatening damage to the body. These immunomodulators were developed, for example, for the treatment of arthritis or inflammatory bowel disease.

Medicines to protect the lungs are intended to prevent the lungs from no longer supplying the blood with sufficient oxygen. The drugs were developed, for example, against idiopathic pulmonary fibrosis, which is often fatal, in which the pathological proliferation of connective tissue between the alveoli and the blood vessels surrounding them causes the lungs to stiffen.

Many COVID-19 patients have to be artificially ventilated

Active ingredients against SARS, MERS, Ebola, influenza

The obvious thing to do, of course, is to rededicate antiviral drugs that have already worked against other coronaviruses. After all, both Severe Acute Respiratory Syndrome (SARS) and Middle East Respiratory Syndrome (MERS) are caused by coronaviruses. And the new pathogen SARS-CoV-2 is considered a variant of the SARS pathogen from 2002.

The active ingredient originally developed against Ebola infections showed in the laboratory Remdesivir also effective against SARS and MERS coronaviruses. However, the remdesivir developed by the US pharmaceutical company Gilead Sciences was not completely convincing in clinical studies. In the ACTT-1 study by the US National Institute of Allergy and Infectious Diseases (NIAID), the disease time was shortened, but a decrease in mortality could not be reliably demonstrated. This is why Remdesivir is now mainly used in the early stages of the disease, when the focus is on virus replication.

The Japanese flu drug caused a real hype, first in Asia and then worldwide Avigancontaining the active ingredient favilavir, which has been approved in Japan since 2014 and now also in China. It was developed by the pharmaceutical division of Fujifilm Holding in Japan. This antiviral is actually used against influenza because it inhibits the viral RNA polymerase and, like remdesivir, is supposed to work against various RNA viruses. In 2014 it was successfully used against Ebola. In 2016, the Japanese government delivered favipiravir to Guinea as emergency aid to fight the Ebola disease.

According to the current status, the drug can shorten the duration of the illness, but it has very strong side effects.

As a supposed Corona miracle cure, Ivermectin traded - especially in Latin America, because the drug for the treatment of parasitic diseases in animals and humans is inexpensive and can be sold without a prescription. It is actually used for scabies or worm diseases. The effects are based on the binding to chloride channels, which leads to paralysis and death, for example, of itch mites and roundworms.

But after Australian researchers reported in June 2020 in the specialist journal “Antiviral Research” that ivermectin was significantly reducing the viral load of the coronavirus SARS-CoV-2 in a preclinical in-vitro study, i.e. under laboratory conditions, a true hysteria began surrounding the drug .

A really reliable proof of the effectiveness is still pending. The World Health Organization and the US Food and Drug Administration (FDA) advise against the use of ivermectin for COVID-19 treatment and warn of side effects. More tests are needed to determine whether ivermectin could be useful for preventing or treating coronavirus or COVID-19.

The South African drug authority SAHPRA also advised against its use at the end of December 2020: There are still no confirmatory data on ivermectin for use in the treatment of COVID-19 infections. In terms of safety and effectiveness, there would be no evidence to support ivermectin's use, and we don't have any clinical studies to justify its use.

Active ingredients against malaria

The well-known anti-malarial drug caused a lot of excitement Resochinafter US President Donald Trump voted for the use of Chloroquine in the treatment of COVID-19 sufferers.

In tests in Marseille, the active ingredient chloroquine should have shown an inhibition of the multiplication of the novel coronavirus in cell cultures, which reduces the viral load of the patients in more severe disease courses. The active ingredient can therefore also be used antivirally, according to the doctors.

The hype was unnecessary, chloroquine is suitable as an antiviral agent against the COVID-19 pathogen

As a result, other malaria drugs with the similar active ingredient were also tested Hydroxychloroquine. In the meantime, however, several studies have shown that these active ingredients do not help against SARS-CoV-2. The research results published in the specialist magazine "Nature" by scientists from the German Primate Center (DPZ) in Göttingen, the Berlin Charité and the University Hospital in Bonn show that chloroquine does not suitable drug for the treatment of an infection with SARS-CoV-2, it simply does not work.
 

Active ingredients against HIV, cancer, multiple sclerosis, asthma, etc.

High hopes are also attached to an HIV drug with the active ingredient combinationLopinavir / ritonavir. The corresponding drug Kaletra from the US pharmaceutical company AbbVie has already been used on a trial basis as a COVID-19 therapeutic in China, Thailand and Singapore. The results are inconclusive, however, and further studies will have to follow.

According to the Association of Research-Based Pharmaceutical Companies, various antibodies and immunotherapeutics are also being tested for their effectiveness against the new coronavirus. The already approved or experimental active ingredients include the Leronlimab antibody from CytoDyn, originally developed against HIV and triple-negative breast cancer, two antibodies originally developed against MERS from Regeneron, and the active ingredient brilacidin from Innovation Pharmaceuticals, which is actually intended for the treatment of inflammatory bowel diseases and inflammation of the oral mucosa was.

In addition, there are a large number of active ingredients that are being developed or already approved, for example against flu, multiple sclerosis (MS), breast cancer, arthritis, asthma, inflammation of the pancreas or hepatitis. They are now also being tested for effectiveness against SARS-CoV-2.

The anti-inflammatory drug dexamethasone is already used. Studies have shown that this corticosteroid can reduce the mortality rate of critically ill patients who depend on oxygen by about a third.

In China, Novartis' MS drug fingolimod and cancer drug bevacizumab have been used in COVID-19 patients with acute lung problems. The antibody tocilizumab from Roche, which is normally used in rheumatoid arthritis and other forms of arthritis, is also said to help with lung damage caused by the SARS-CoV-2 pathogen.

A German consortium led by the German Primate Center in Göttingen is also planning clinical studies with the active ingredient Camostat Mesilat. This active ingredient, approved in Japan against pancreatitis, inhibits an enzyme in lung cells that is essential for the SARS-CoV-2 virus to penetrate.

This article has been updated several times, most recently on January 7, 2021.

 

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