In Nebraska, researchers are investigating whether an experimental drug, remdesivir, can treat COVID-19, the disease that results from a coronavirus infection. In New York, Governor Andrew Cuomo announced on Monday that the state would begin studies on the combination of hydroxychloroquine and Zithromax.
Overall, more than 100 clinical trials with dozens of potential treatments have started in several countries.
However, the start of these studies does not mean that treatment is imminent.
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“There is an enormous demand for new treatments,” said Dr. Caleb Alexander, professor of epidemiology and medicine at the Johns Hopkins Bloomberg School of Public Health. “But nobody is well served if they offer treatments that have not been adequately tested.”
Before new drugs are released, they must undergo rigorous testing to ensure that they are both safe and effective. The consequences, if not done, can be dangerous: in the 1970s, for example, the United States pushed for rapid work on a flu vaccine that was later linked to hundreds of cases of Guillain-Barré syndrome, a type of paralysis.
“The world relies on the scientific company to do it right,” Alexander told NBC News. “There are literally hundreds of thousands of lives on the line.”
The world relies on the scientific company to do it right.
Proper research into new drugs, especially drugs used to treat a brand new virus, focuses on a randomized controlled clinical trial. In its most basic form, researchers randomly assign patients either the experimental drug or a placebo.
In the best of circumstances, neither the researchers nor the participants know which pill (the real pill or the dummy pill) is assigned to each patient until it is time to look at the results.
Doctors say it’s the gold standard for making certain treatments safe and doing what they’re supposed to do. The only downside is that these tests can take months or even years to complete. However, side effects and safety problems may not be immediately apparent. Therefore, longer testing times are required to carefully look for problems that the drug can cause.
“There is really no substitute for clinical trials that generate knowledge for the general public so we can find out what works and what works for most people,” said Dr. Jess Mandel, director of the Department of Lung, Intensive Care and Intensive Care Medicine at the San Diego School of Medicine at the University of California, said.
Mandel admitted that it can be tempting to give patients everything they can to help. However, when patients receive unproven and unexamined treatments, they are at risk.
“On the one hand, you want to throw out anything that might be helpful to patients who have problems and don’t refuse anything that could be useful,” said Mandel. “On the other hand, every drug has side effects.”
In some cases, doctors can use medication on patients who have not yet gone through clinical trials through what is known as compassionate use. It is important that experimental therapies are carried out under medical supervision.
“We make well-founded assumptions based on very small studies,” said Dr. Adam Jarrett, Chief Medical Officer at Holy Name Medical Center in Teaneck, New Jersey.
“We shouldn’t do this lightly because you really want to offer evidence-based medicine,” he added. “They want to know that drug B works if patient A has a problem.”
In fact, research is also needed to show which drugs do not work. The first one last week Main study Examination of a combination of HIV drugs, lopinavir and ritonavir, for use in coronavirus patients showed no benefit.
Despite extensive research into which treatments are most suitable for the coronavirus, it is possible that a cure may elude scientists.
“This is a new disease, so we know very little about it,” said Jarrett. “Compare it to HIV, where we know a lot about it, but we haven’t yet found a vaccine for it.”
And despite decades of research into the influenza virus, the annual flu shots are only partially effective.
Nevertheless, coronavirus research is expected to provide at least some answers to doctors’ most pressing questions about the new virus, including what may be the most useful medication and when to administer it.
There is some early evidence that antiviral drugs may be most effective for coronavirus shortly after infection. This is very similar to Tamiflu, which is used to treat the flu. Ideally 24 to 48 hours after the onset of symptoms.
However, doctors have found that in the most severe COVID-19 cases, symptoms are mild and smoldering for about a week before people get pretty sick and need to be hospitalized. This means that you may not receive a drug until days after its effectiveness has ended.
“If people have been sick for five to seven days before landing in the intensive care unit, that is a big challenge for you [antiviral] Deliver drug, “said Mandel.
“As the fog of war clears a bit, we have to think about the best treatment strategies,” he said, adding, “We still have a lot to do.”
There are innumerable experimental treatments in the works, including chloroquine for malaria, alone and in combination with an antibiotic called azithromycin (better known as Z-Pack).
The researchers are also investigating remdesivir, an antiviral therapy that is believed to prevent the virus from reproducing in the body. “Convalescence serum”, obtained from plasma donated by restored coronavirus patients, has also shown promise.
Other drugs with coronavirus fighting potential are immunosuppressive drugs, so-called interleukin-6 inhibitors, which are already used to treat rheumatoid arthritis. Researchers believe the drugs can suppress dangerous inflammation in the body.
“There is an enormous demand for new treatments, but we have to let science do its job,” said Alexander. “The stake couldn’t be higher.”