Monoclonal, oral and intravenous antiviral antibodies. The point on anti Covid drugs
Vaccines, according to Italian and non-Italian data and studies, are the best weapon available against the virus, but also some anti Covid drugs can, or could, help patients and the health system. Here is the latest news on monoclonal, oral and intravenous antiviral antibodies.
ORAL ANTIVIRALS: MOLNUPIRAVIR AND PAXLOVID
The oral antivirals molnupiravir and paxlovid, commonly known as the anti Covid pills, the first produced by Merck and already distributed in Italy since January 4, the second produced by Pfizer and arriving at the end of January, are indicated for patients with mild or moderate and at risk of developing severe disease. It is essential to administer them within 5 days of the onset of symptoms.
These drugs, the only ones that could be taken without being hospitalized, had to represent a turning point in treatment and ease the pressure on hospitals and instead some doctors report a malfunction in the prescription and administration process.
WHAT PROBLEMS ARE THERE WITH ORAL ANTIVIRALS?
“There could be some inefficiency in the health system, I am thinking for example of the quantification of the amount preventable with antivirals within five days of infection. While vaccines are offered to everyone, these drugs are at risk of inequality and we need a campaign on the issue involving general practitioners, ”said Stefania Salmaso , epidemiologist and former director of the National Epidemiology Center of the Higher Institute of Health (Iss ).
Yes, because timing is essential and then, writes Repubblica , there is the dilemma "to whom to reserve these drugs?". The rule is "for those who risk progressing towards a serious form of disease" and, says Francesco Menichetti, the infectious disease specialist at the University of Pisa, often they are unvaccinated: "we reserve at least half of the treatments for them".
"And while the criterion of advanced age was enough for monoclonals, being elderly is not enough to obtain antivirals", added Massimo Andreoni, who directs infectious disease at the Tor Vergata Polyclinic in Rome. In fact, there must also be other pre-existing diseases.
FORECASTS ON ANTI COVID DRUGS
“The time will come when drugs will become decisive, as happened with the HIV pandemic, but we are not there yet. And we are spending an enormous amount of resources to treat a minority of the population that does not want to get vaccinated for purely ideological, irrational reasons, ”Paolo Maggi, an infectious disease specialist at the Caserta hospital, told the newspaper.
WHAT AIFA SAYS
Among the drugs that can be used for the treatment of Covid-19 disease indicated by the Italian Medicines Agency (Aifa) there are: sotrovimab, remdesivir, anakinra, baricitinib, sarilumab, tocilizumab, heparins.
On the basis of the available scientific evidence, the protease inhibitors lopinavir / ritonavir and darunavir / cobicistat used in the early stages of the epidemic were suspended.
Furthermore, cortisterioids and antibiotics have been indicated only in rare specific cases, while hydroxychloroquine is not recommended since no efficacy has ever been confirmed.
Sotrovimab, which is in the spotlight because it is nowhere to be found and the only monoclonal effective against the Omicron variant, is recommended for the treatment of mild or moderate Covid in patients at high risk of hospitalization, such as the elderly, immunocompromised individuals, with underlying conditions such as diabetes. , hypertension and obesity.
Remdesivir is an intravenous antiviral that has also shown good results against Omicron. "Oral and intravenous antivirals such as paxlovid and remdesivir retain their efficacy against the Omicron variant and may help limit the disease burden associated with this variant," said Marco Cavaleri , head of vaccination strategy at the European Medicines Agency recently. (Ema).
It is indicated for patients with mild or moderate disease and at risk of developing severe disease because they already have a risk factor such as a disease. It should be administered within 7 days of the onset of symptoms.
Anakinra, known as Kineret , is an immunosuppressant already authorized in the EU for various inflammatory conditions. It was already in use for the treatment of rheumatoid arthritis and Still's disease, as well as periodic fever syndromes, namely Cryopyrin Associated Periodic Syndromes (CAPS) and Familial Mediterranean Fever.
It can be used to treat Covid in adult pneumonia patients who require supplemental oxygen (low or high flow) and who are at risk of developing severe respiratory failure.
Baricitinib, recently recommended by the World Health Organization (WHO), is indicated for patients with severe or critical Covid-19 and its administration with corticosteroids is suggested. As a Janus kinase inhibitor (JAK) it suppresses the overstimulation of the immune system. It is an oral drug, used in the treatment of rheumatoid arthritis.
SARILUMAB AND TOCILIZUMAB
Sarilumab and tocilizumab are two monoclonal antibodies also used for rheumatoid arthritis. Both are indicated for seriously ill patients and should be taken together with corticosteroids. These monoclonals work by blocking the excessive immune reaction that often develops in Covid patients.
Heparin is the drug behind some nasal sprays being studied to prevent infection . As for the efficacy in patients who have Covid, Aifa suggests using it only in rare cases, for example, in subjects with acute respiratory infection who are bedridden or with reduced mobility since "there is currently no solid evidence / sufficient data to recommend a routine use of intermediate or therapeutic doses ".
This is a machine translation from Italian language of a post published on Start Magazine at the URL https://www.startmag.it/sanita/farmaci-anti-covid-quali-sono-consigliati-e-quali-no/ on Wed, 19 Jan 2022 14:16:20 +0000.