Repurposed Drugs for COVID-19: Anti Inflammation Drug Gets the Nod
Can repurposing drugs be the way forward to treat coronavirus?
China has recently approved the use of Swiss drugmaker Roche's anti-inflammation drug Actemra for patients with severe complications of COVID-19, reports Reuters. This is the latest drug to get approval amid several experiments that are taking place to address the novel coronavirus outbreak that first emerged in a wet animal market in Wuhan in mid-December. Actermra is distributed in India by Cipla.
In extreme cases of coronavirus, some patients develop severe cytokine release syndrome (CRS), or cytokine storms, which is an over reaction of the immune system. CRS is behind multiple organ failure in these cases.
Actemra is primarily used for rheumatoid arthritis (RA) and was approved in the United States in 2010. In 2018, Cipla in India entered into a distribution agreement with Roche.
China’s National Health Commission has said that Actemra can now be used to treat coronavirus patients with serious lung damage and high IL-6 levels.
While clinical data on the drugs efficacy has yet to be established, with over 3000 deaths, experimental drugs are being used to treat coronavirus cases.
Worldwide the hunt is on to find a treatment and the World Health Organisation has tweeted about how much they have discovered about the virus in a short period of time.
Repurposed Drugs to Tackle Coronavirus
The Chinese companies are already gearing up to create an alternate to Roche's treatment, reports Reuters. In fact they have been repurposing existing drugs that have been used to deal with other previous virus outbreaks.
These include a combination of HIV drugs and other anti virals.
Earlier in February, the Drug Controller General of India (DCGI) had consented to the ‘restricted use’ of a combination of anti-HIV drugs for treating those affected by COVID-19, after the Indian Council of Medical Research had sought an emergency approval for the use of the two drugs — ‘lopinavir’ and ‘ritonavir’.
According to a Reuters report, doctors from Rajavithi Hospital in Bangkok have successfully treated severe cases of the virus using a combination of drugs for flu and HIV. In fact, a 70-year-old Chinese woman from Wuhan, who had tested positive initially, showed improvement within two days. Dr. Kriangska Atipornwanich, a lung specialist at Rajavithi, told reporters,
"This is not the cure, but the patient’s condition has vastly improved. From testing positive for 10 days under our care, after applying this combination of medicine the test result became negative within 48 hours"Dr Kriangska Atipornwanich
The combination includes a mixture of anti-HIV drugs lopinavir and ritonavir, along with the flu drug oseltamivir in large doses.
Another antiviral drug, called remdesivir, which had initially been developed to fight Ebola, was used to treat the first patient affected by the Wuhan coronavirus in the US. IANS reports that the Wuhan Institute of Virology has applied for a patent in China for the use of this antiviral therapy.
The Indian pharmaceutical major Cipla, is also reportedly keeping a stock ready of the two anti-HIV drugs. Chairman Yusuf Khwaja Hamied said that these medicines are off-patent and are now being repurposed to deal with the new virus. “We are now approaching the Indian government that in case of any emergency, we will rise to the occasion and help,” a Business Today report quoted him as saying.
However, in all the cases where improvement has been observed in patients, researchers have asserted the need to hold randomized control studies to be sure of the safety and efficacy of these medicines.
In fact, one of the patients in Thailand showed an allergic reaction to the drug cocktail, raising doubts for any universal application.
Indian Experts Weigh In: Are These Drugs Reliable?
In an earlier interview, FIT had spoken with Dr Naga Suresh Veerapu, a virologist and assistant professor at Shiv Nadar University, who said that it is difficult to believe that antiviral drugs could be effective in all cases. SARS was a similar strain, and there is no treatment modality for it yet.
“I will not rule out the possibility, but I am doubtful it could be an absolute treatment.”
However, until a vaccine is developed, which could take at least a year, testing antivirals could be a quicker alternative, he said.
Dr Veerapu says that the idea behind approving these drugs is that they have already been tested for previous illnesses. So we know they are safe, and if they work against the new strain, it would be great. ‘Repurposing’ the drugs, as this is called, could be the fastest possible solution to the epidemic.
The only way forward, therefore, is clinical testing of these drugs. Efforts in this direction are already underway, with China testing an HIV medicine called Aluvia (a fixed-dose combination of lopinavir/ritonavir) as a treatment option, reports suggest.
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