As in any new disease, a major obstacle in the covid epidemic has been the lack of treatments, no longer specific, but moderately effective. By having vaccines, you wonder if they have already won the research race. Will the treatments be unnecessary? Scientists say no and studies continue.
The vaccines have been obtained in less than 10 months, probably sooner than many anticipated. And those of the pharmaceutical companies Pfizer / BioNTech and Moderna, according to the tests, have a very high efficiency (95%). These injections prevent suffering from covid in a serious and moderate way. So they would make treating the disease almost unnecessary.
This month the Clotet i Mitjà team will direct a rehearsal of a Grifols theater
Bonaventura Clotet, director of infectious diseases at the Germans Trias i Pujol hospital in Badalona, IrsiCaixa and the Fight Against AIDS Foundation, indicates that “vaccination will surely be an effective response against the pandemic.” But he believes that the treatments “will complement it, they can be used in parallel.”
According to him, because the therapies will be needed while the vaccines do not reach everyone (there have already been production or supply limitations) and take effect. They will be used for people who cannot be vaccinated; if the injections are not all equally effective or in all population groups and ages; if its effect has a limited duration and if the virus remains active for a long time and generates variants or resistance (although they could affect vaccines and treatments). Even after the epidemic ends, SARS-CoV-2 can continue to cause serious infections. Therefore, the doctor maintains that further investigation should be carried out.
Read also
The same thinks Nuria Verdaguer, director of the Institut de Biologia Molecular de Barcelona (IBMB -CSIC), who points out that the advances may also be used for other infections. The vaccine would not have gone so fast if the research had started from scratch. Verdaguer believes that a greater investment effort has been made in seeking vaccines than treatments.
Even so, research on therapies is extensive, under pressure from the large number of patients. These are the main lines:
Neutralizing antibodies
They are the axis of specific therapies against covid. When infected, the body generates antibodies to neutralize the virus that prevent it from replicating. The vaccine also activates them. And this type of treatment injects antibodies into the body to accelerate and strengthen its response, to stop the infection, prevent it from getting worse. It transcended the trial of this therapy when it was given to Donald Trump, but it is evolving. It began using convalescent serum, plasma from people who have passed the infection (it is also used from healthy people, who make antibodies against common viruses). That perfusion has become more sophisticated. The last formula is the therapy that the Catalan pharmaceutical company Grifols will test in the northern metropolitan area of Barcelona (together with other scientific centers).
The new threat of virus variants
As with vaccines, laboratories with antibody treatments have also begun to analyze this last week if their therapies will work the same against the South African variant of the virus, which appears to cause a decrease in antibodies. And the same could happen with another detected in Brazil. Early studies in Regeneron’s laboratory with Columbia University and the US public health system have pointed out that with this company’s treatment, which includes two antibodies, one preserves its potential, while the other loses it, And the same would happen with Lilly’s therapy, except when combined with another drug. Both seem to work against the British variant. The two companies have said they will review their treatments. Lilly announced that it will test more antibodies (there are many types) that fight the South African strain and see if it strengthens its therapy. To do this, they will test your bamlanivimab with an antibody from GSK. And it is that the dynamics in vaccine research can also influence the search for treatments. Large laboratories such as Merck, which a few days ago abandoned the trials of a vaccine, plan to dedicate more effort to possible therapies against COVID. The same is true of other pharmaceutical companies without an immunogen, such as Novartis or Sanofi, which will also produce the Pfizer vaccine.
“We are going to test a hyperimmune immunoglobulin (Ig) that potentiates the convalescent plasma antibodies ten times,” explains Clotet, who, together with Oriol Mitjà, his team’s infectologist, will lead the test in 800 people from this February. Antibodies (from different donors who have passed the covid) are selected and concentrated to activate their effectiveness to the maximum and attack different parts of the virus – that is why it is called polyclonal therapy, as opposed to monoclonal, which fights only part of the virus, in in general, the S– protein. These antibodies become a drug that will be administered by subcutaneous injection, as opposed to intravenous infusion applied in the US This way, it could be used more easily in CAPs, in hospital emergencies or even in residences, to avoid hospitalizations, indicates Clotet. Expect study results for May.
Extraction of blood from a patient who has passed COVID to obtain antibodies
Grifols also has Ig already approved against other ailments, which are also tested to treat covid in Spain and the US, in hospitalized patients and the ucis, details Antonio Páez, the company’s medical director.
The companies Regeneron and Eli Lilly also created monoclonal antibody therapies, both of which are authorized for emergencies (they are used, but are still under study) in the US That country wants to extend them: it has ordered 3.5 billion euros in doses from both companies , reported Bloomberg . Germany has also bought 200,000 doses for 400 million. Lilly has already requested approval of her therapy in the European Union, says José Antonio Sacristán, the company’s medical director in Spain.
The US has bought doses of antibody therapies worth 3.5 billion euros
Trials indicated that antibodies reduce viral load and prevent hospitalizations for worsening infection, but studies with patients give mixed results. Ten days ago, a study saw little effect of Lilly’s bamlanivimab in non-seriously infected patients, although it did combine with another drug, etesevimab. The company said that another trial demonstrates a remarkable preventive effect of its antibody in people at risk if they contract COVID, such as those who live in residences. You want to promote a more preventive use (give it to people before becoming infected). Same thing Regeneron. Instead, the University of Oxford has stopped a trial with convalescent plasma, seeing that it does not reduce mortality.
For Clotet, a key to antibody therapy seems to be in which phase of the infection it is used, since not much effect has been observed in already seriously ill patients, but the earlier it is administered. In the Grifols trial, infected people will be injected in the last 72 hours, without symptoms. The doctor explains that it will also be analyzed if it activates a molecular mechanism that prevents the so-called cytokine storm, the hyperreaction of the organism that occurs in many cases of covid and aggravates the state of the infected.
Antivirals
Faced with the avalanche of seriously ill patients, doctors and scientists began to review what existing drugs could combat COVID. The first to look were antivirals, although the success of the recycling it has been limited, says Verdaguer. This is illustrated by the case of remdesivir, used, although several studies have not found it effective. Verdaguer and his group are investigating (they are still in a basic phase) a cocktail of antivirals, bringing together at least two different ones (favipiravir and ribavirin in their case) to attack different mechanisms of the virus. The drug cocktail is a spreading strategy; in his day he managed to stop the mortality of HIV-AIDS.
Another IBMB team is testing drugs against the cytokine storm. Verdaguer clarifies that this virus is not more complex than others, but investigating takes time. More antivirals are being tried, such as sofosbuvir, which changed hepatitis.
Anti-inflammatories
It is another type of medicine that is used to treat the hyperinflammation that covid causes in some cases. Like dexamethasone, widely used. Hydroxychloroquine, widely used in the first wave, was later discarded. Grifols tests your alpha-1 antitrypsin; Oxford, tocilizumab (which is used against rheumatoid arthritis) and Lilly, its baricitinib, also in cocktail with remdesivir. Sacristán presumes that “two of the four drugs approved against covid in the US are from Lilly.” After the first wave, the use of these drugs earlier is considered one of the factors to reduce admissions in ucis and deaths.
Read also
Anticoagulants
Another of the families of drugs that are given to many patients to prevent and treat venous or arterial thrombosis, pulmonary embolism and the stroke that causes the infection. The World Health Organization (WHO) insisted this week that these drugs be used. And even a classic is being tried, aspirin.
Many more drugs are being studied, such as colchicine for gout. Scientists from the Universitat Politècnica de Catalunya have seen results with raloxifene. Others from the ISGlobal institute and the University of Navarra Clinic, with the antiparasitic ivermectin. A study led by Adolfo García-Sastre, a virologist at Mount Sinai Hospital in New York, analyzed 47 drugs and several were active against the virus, especially the antitumor plitidepsin. At the Clotet center (in consortium with others) they already saw that it was the most potent against the virus of 70 molecules analyzed.
–
