Tue, 03/31/2020 - 21:23
In today’s search, I looked for treatment. The first three papers summarize a number of options, including:
- Nucleoside analogs: Favipiravir, Ribavirin, Remdesivir. As indirect evidence, Remdesivir has been tested against MERS in macaques with a favorable outcome (4th paper). Are there studies with Ribavirin or Favipiravir in animal models of Corona infection?
- Neuraminidase inhibitors: based on a study of patients, suspected but not confirmed with MERS (5th paper)
- Protease inhibitors. The outcome of the first randomized clinical trial with LPV/RT in COVID-19 is negative (6th paper)
- The combination of Arbidol with LPV/RT showed a beneficial effect in a small study of non-critical patients (7th paper). Arbidol is apparently a fusion inhibitor with broad-spectrum activity.
- Type 1 interferon is also mentioned, of course, but I could not find clinical or animal evidence.
- Chloroquine has been studied in a small trial with reportedly good results, but formal trials are ongoing. I add a nice review on possible actions of Chloroquine, which is certainly scientifically interesting to consider.
- Corticosteroids are also mentioned, as there is hyper-inflammation, of course. It seems to me that they have been used in a rather uncontrolled way in Wuhan.
- There is a number of novel ideas and concepts that are still need in a very early phase to be tested
- The last paper offers a rather sobering systematic review on SARS, showing that inconclusive or even harm in 30 trial with Ribavirin, 29 with corticoids; 7 with convalescent plasma, 3 with IFN and 2 with LPV/RT
Prophetic quote: Treatment of SARS and MERS in outbreak settings has focused on therapeutics with general antiviral activity and good safety profiles rather than efficacy data provided by cellular, rodent, or nonhuman primate models of highly pathogenic coronavirus infection. Based on lessons learned from SARS and MERS outbreaks, lack of drugs capable of pan-coronavirus antiviral activity increases the vulnerability of public health systems to a highly pathogenic coronavirus pandemic (Allison L. Totura & Sina Bavari in Expert Opinion on Drug Discovery, published online 08 Mar 2019).
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