From August 30 to 1is September 2021, the National Days of Infectious Disease took place within the Corum de Montpellier. The opportunity for the various experts in the specialty most mobilized since the start of this pandemic to discuss and come back to several subjects. One of them was the advancement of treatments against Covid-19.
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It is under the soleil from Occitania that the community of infectious diseases met from Monday August 30 to Wednesday 1is September. An edition naturally marked by the pandemic of coronavirus. On this occasion, Professor Karine Lacombe, Head of the Infectious and Tropical Diseases Department at Saint-Antoine Hospital in Paris, presented an overview of therapies against the Covid-19. We offer you a brief summary.
Simple and effective measures
For a very empirical discipline like medicine, a new disease is always a challenge. New clinical signs to identify, new biomarkers to look for, new therapeutic strategies to put in place. If the blur dominated during the premiere vague, things are now clearer. For example, the prone position, which was initially controversial, is now recognized as having significant efficiency on the mortality of patients with Covid-19, as well as anticoagulants. On the side of antivirals, nothing new. It seems that the Solidarity trial provided a clear and definitive answer regarding the ineffectiveness of all repositioned antivirals against Covid-19, as we said in the article below.
The hope of monoclonal antibodies
The monoclonal antibodies quickly became a hope in the face of Covid-19. A recent analysis published in review mAbs shows that many trials are still underway in different therapeutic indications. In the Recovery trial, one interesting thing should be pointed out. If overall mortality is not impacted by takingantibody monoclonal, mortality according to the patient’s serology is. This constitutes a strong argument for testing these therapies during the very early stages of the disease. But a logistical problem arises: how to treat patients during the early phase given that during this phase, they generally have no symptoms and therefore do not show up in care services? The Recovery trial also concluded that the ineffective transfusion from plasma blood.
Corticosteroids take center stage
Unsurprisingly, the corticosteroids, especially dexamethasone, have become the standard treatment in the management of severe forms of Covid-19. They have a strong impact on mortality although care should be taken when using them. Indeed, the inflammatory response being reduced (which saves the patient’s life), there are significant risks of infectious complications, especially in a Covid context where the prescription ofantibiotics was exacerbated in hospital (unlike in city medicine where it seems to have fallen) while secondary infections only occur in 5% of cases in Covid + patients. Other treatments are being studied, some have already demonstrated their ineffectiveness, while for others it is too early to know the results.
Solidarity: no tested treatment is effective against Covid-19
By Julien Hernandez on 10/20/2020
The four treatments tested against Covid-19 are ineffective according to the global Solidarity trial led by the World Health Organization (WHO).
To deal with the Covid-19 pandemic, we needed answers. Answers we didn’t have. From then on, the scientific community got down to work. Some lost sheep have taken refuge in the argument of urgency. It was not a tenable position. Whether from a scientific point of view or an ethical point of view.
This probably resulted in difficulty recruiting patients for some people clinical tests. Serious scientists did not rush. They kept a cool head. The time of modern medical science is not that of clinical observation isolated. It takes time to know if you are treating a new disease properly.
Today, we know that the four anti-viral drugs repositioned to fight Covid-19 are ineffective. They do not provide any additional benefit beyond the effect placebo and standard care. It’s a bummer, but we know. We can look elsewhere, leaving it calmly behind us.
A major trial
The drugs studied were: remdesivir, lopinavir, interferon beta and thehydroxychloroquine. It is a randomized phase 3 trial, against placebo + standard care, and multicenter given that it was carried out in no less than 405 hospitals simultaneously around the world. In total, more than 11,200 patients were included in the experiment. The study is currently in pre-publication. To ensure the reliability of the results, it will therefore be necessary to wait for its publication, already planned in the New England Journal of Medicine.
Remdesivir was administered intravenously at a level of 100 mg per day for 9 days, except for the first day when a loading dose of 200 mg was injected. L’hydroxychloroquine, meanwhile, was delivered orally at a level of 1,240 mg on the first day, then 620 mg per day for 10 days. Same thing for le lopinavir, 400 mg per day for 14 days with 50 mg of ritonavir in addition to counter the deleterious effects of lopinavir on our foie.
Beta interferons were used in subcutaneousup to 132 micrograms over 6 days (3 administrations of 44 micrograms each). The criteria used to judge the effectiveness of the treatments were mortality at 28 days initially, and the need for ventilation and the duration of hospitalization in a second step.
Disappointing but reliable results
The authors’ conclusion is clear: “ The main outcomes of mortality, the need for ventilation and the length of hospital stay were not clearly reduced by any drug in the study ”. With such a large sample, it seems these are the most robust results available so far from the trial. Recovery. Indeed, the larger the sample size, the greater the chance of detecting minor effects, but potentially useful in saving lives at the scale of a population.
From now on, world medical research will be able to turn the page concerning these four treatments. She will focus on other therapeutic avenues waiting for developing a vaccine. The few doctors who support hydroxychloroquine, who continue to prescribe it as a treatment against Covid-19, are now doing so against the scientific data in our possession.
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