AFPpublished on Thursday 18 June 2020 at 22: 05
On one side, dozens of drugs tested. On the other hand, a hundred vaccines in the project. Whether to treat the Covid-19, or to prevent, the research abound and are moving forward quickly, even if it is still waiting for the discovery that will change the course of the disease.
TREATMENTS: HOPE, EXPECTATIONS
– Dexamethasone: avoid dead
Cheap and easily available, this steroid is at this point the only drug that appears to improve survival in patients with the Covid-19.
This does, however, concern that patients most severely affected: those who are placed on artificial ventilation and, to a lesser extent, those in which oxygen is administered without intubation.
In the first, dexamethasone reduces the mortality of a third party, according to initial results of a large clinical trial british Recovery.
Announced Monday, these results have not yet been published in a scientific journal. But in the aftermath, the british government has announced that this treatment would be immediately used to treat the patients concerned.
The dexamethasone is already used in many indications for its potent anti-inflammatory effects and immunosuppressive.
– Remdesivir: modest efficacy
This antiviral drug is promoted by the United States, which had officially announced end of April that it would reduce the time of recovery of the sick.
The publication of this research at the end of may in the New England Journal of Medicine has confirmed these assertions.
Nonetheless, the effectiveness of the remdesivir is not spectacular: it increases the duration of recovery of the hospitalized patients from 15 to 11 days on average, and there was no evidence of benefits in terms of mortality reduction.
The use in emergency remdesivir in hospitals has been authorized by the United States, and then Japan. Europe is in the process of studying an application for authorisation of the placing on the market.
Manufactured by the laboratory Gilead, the remdesivir had been initially developed – in vain – against the Ebola hemorrhagic fever.
– Hydroxychloroquine: scottish shower
Touted by us president Donald Trump and the French researcher controversial Didier Raoult, this treatment has not confirmed the hopes placed in him, quite the contrary.
In early June, the clinical trial british Recovery has found that hydroxychloroquine had no beneficial effect against the Covid-19.
This observation led to Monday the u.s. health authorities to withdraw authorisation for use in emergency hydroxychloroquine against the Covid-19 (as well as a drug in the near future, chloroquine).
Then on Wednesday, the WHO (world health Organization) announced that it would stop clinical trials of hydroxychloroquine as a treatment of Covid-19.
Used according to the countries as a treatment of malaria and of autoimmune diseases, this medicine is at the center of a long saga to the very policies from the start of the pandemic.
A saga marked by a scandal academic: in early June, the prestigious journal The Lancet had to retract a critical study on hydroxychloroquine, are associated with strong suspicions of fraud.
This scandal has been confirmed by the opinion of the rabid supporters that keep the drug despite the evidence to accumulate.
– A pharmacy full
In addition to the three drugs mentioned above, many others are under evaluation. In total, over one thousand clinical trials include dozens of treatments around the world, according to the base of the Lancet (https://covid-trials.org/).
Among the main potential treatments, the combination of two anti-HIV drugs, lopinavir and ritonavir (alone or in combination with other antivirals), the blood transfusion to the patients in the blood plasma of people who have been cured, chlorpromazine (an antipsychotic drug), or tocilizumab (that may fight against inflammatory phenomenon responsible of the most severe cases).
But despite the effects of ad in a race that was very competitive, none of these tracks do for the time being proved successful.
As much as it seems illusory to believe in a miracle product against the Covid-19: most specialists think that the key will not be a single molecule but a combination of several drugs from different families, in order to add up their effects.
VACCINES: THE RACE ACCELERATES
– How many vaccines?
In his last point, to 16 June, WHO are 11 ongoing clinical trials for both vaccine candidates around the world.
Almost half of these tests on the man are in China (5). This country, which has seen the emergence of the virus SARS-CoV-2, and feared a resumption of the epidemic in Beijing, wants to be the first to have a vaccine and does not hesitate to allow accelerated procedures.
The ongoing clinical trials in the world for “vaccine candidates” are so-called “phase 1”, i.e. they are designed primarily to evaluate the safety of the product, or “phase 2”, to know that they already assess their effectiveness.
Only partial results, some described as “encouraging”, were published for the moment.
Among the most advanced projects, we can mention the european, of the University of Oxford in cooperation with AstraZeneca and the, chinese, Academy of military medical sciences and the pharmaceutical company CanSinoBIO.
In addition to the testing already started, WHO accounts for 128 projects of vaccine candidates that are in pre-clinical phase of development.
Another count conducted by the british school of medicine, London School of Hygiene & Tropical Medicine are no less than 194 projects of vaccines, anti-Covid, of which 17 are at the stage of clinical trials.
– Different approaches
The WHO has classified the hundreds of ongoing projects in eight different categories corresponding to types of vaccines, proven or, on the contrary, experimental.
It is of classical type vaccines “live attenuated” or “inactivated” vaccines are called “subunit” proteins (presenting an antigen to the immune system without viral particles).
It is still vaccine projects called “viral vector”, who use state of the art techniques to produce viruses whose single object is to elicit an immune response in man.
Among the projects are also vaccines “DNA” or “RNA” which are investigational products using pieces of genetic material altered.
– The date, key issue
The european medicines agency (EMA) was estimated in mid-may that a vaccine could be ready by a year in an “optimistic”.
But the more optimistic focus squarely on the end of this year to counter a possible second wave of the pandemic, which could strike the northern hemisphere the next winter.
In the framework of its operation “Warp Speed”, the u.s. government hopes to deliver 300 million doses of vaccine by January 2021 (almost the equivalent of the population of the u.s.), through funding and support to laboratories.
In China, the pharmaceutical company, state-owned Sinopharm, which is currently preparing two vaccine candidates, hopes to launch on the market in late 2020-early 2021.
In Europe, where several projects are also in progress, we hope to also develop with a successful vaccine by the end of this year.
Germany, France, Italy and the netherlands have signed an agreement with the pharmaceutical company AstraZeneca to ensure the supply to the EU 300 million doses of a possible vaccine.
– At what price ?
The pharmaceutical companies have on several occasions referred to the fact that they intend to make available to their vaccine at a reasonable price, or even at cost price.
AstraZeneca is committed to “do no profit on the vaccine”, according to its president, for France, Olivier Nataf, with a price of about 2 euros per dose.
– Who will be vaccinated?
The United States announced their intention to give priority in their future vaccination campaigns, the elderly, citizens with a medical history and workers are considered essential.
According to the us government, this will however depend on results of clinical trials.