What’s Working in Covid Treatments
and What Isn’t
Some therapies that faced early questions are regaining
their promise as we learn more. Others aren’t, but it’s important news either
way.
By Sam Fazeli
January 18, 2021, 7:00 AM EST
New data from a large U.K. trial added to evidence indicating plasma may not make a difference in treating Covid-19.
The arrival of Covid-19 vaccines has put the focus of the
pandemic fight on inoculating as many people as quickly as possible. But
outbreaks are still raging worldwide, with thousands of new infections every
day and health systems under pressure to care for the sick, a reality that will
continue for some time. Vaccine timelines also keep getting more and more stretched.
With that in mind, it’s a good time to take stock of where we are in treating the disease. The short answer is, there’s
progress but it’s mixed.
For months, Gilead Sciences Inc.’s remdesivir and the generic
steroid dexamethasone have been used on the front lines after being shown
to reduce hospital stays and improve recovery speeds. Now, as we learn more
about Covid-19, more treatments — including some that at first drew skepticism
from physicians and scientists — are proving effective in certain circumstances.
Others, such as convalescent plasma, are not. Let’s take a look:
“Toci”: Two arthritis drugs that previously failed in treating
Covid-19 — Roche Holding AG’s tocilizumab
and Sanofi-Regeneron Pharmaceuticals Inc.’s sarilumab — are now
showing a meaningful effect in helping reduce the burden of disease in
some patients. It seems that when the drugs are used is key. The latest
data comes from a trial involving patients who were treated within 24 hours of needing hospital care in an intensive
care unit. The drugs reduced mortality,
suggesting that seven or eight lives would be saved for each 100 people
treated. The hope is that this data will be corroborated in the U.K.’s much
larger and pioneering Recovery trial now underway, with more than 3,000 of the
28,000 and rising participants treated with “toci.” This will provide the most
concrete data behind the drug and will potentially enable global approvals
beyond Britain.
“Bam-bam”: Next
up are new drugs developed by Eli Lilly & Co. and Regeneron, part of a
promising group of therapies called monoclonal antibodies that mimic the
body’s response to infection. Lilly’s bamlanivimab,
affectionately known as “bam-bam,” was the first to gain emergency use
authorization by the Food and Drug Administration. Both Lilly’s and Regeneron’s
treatment have now been cleared for high-risk patients to help prevent
hospitalization. One obstacle for adoption of these drugs has been the
logistics of administering them — they
need to be delivered using specialized infusion equipment. This difficulty was
compounded in bam-bam’s case with a confusing efficacy story and lukewarm
comments about it in the Covid-19 treatment guidelines from the National
Institutes of Health, resulting in doses piling up on hospital shelves. This
situation may be about to change, though, given an early read from a 2,000-patient
Mayo Clinic study in which the use of bam-bam was shown to reduce
hospitalizations and emergency-room visits by 70%. There are also
indications of a reduction in mortality. When data from this study is
published, it is likely to drive increased interest in the use of bam-bam, and
possibly Regeneron’s antibody treatment, too. I do still remain cautious about the broad use of these
drugs because of the risk they may
hasten development of resistant mutations in the virus, which may, though
unlikely, also impact vaccine-induced immunity.
Plasma: Convalescent
plasma, a source of hope in the early days of the pandemic, has had a lot
of subsequent failures and questions about its use. While not a drug per se, it
is supposed to work in a similar way as monoclonal antibodies by giving
patients ready-made immunity in a bottle in the form of plasma from recovered
patients that is full of antibodies to the virus. The problem with previous
attempts in showing a benefit from this approach was a lack of standardization
and its use at the wrong time. Then recent data from a trial in Argentina
raised hopes that if you use plasma with high amounts of antibodies early
enough, when the infection itself is still active, it does make a difference.
Unfortunately, there’s since been another setback, and this time a very serious
one. The U.K.’s aforementioned Recovery trial has been comparing Regeneron’s
antibody treatment and convalescent plasma to standard care without those
treatments in a very large patient group, making the data and its statistical
analysis very robust. Findings released Friday from the trial showed no
difference in the mortality of those receiving plasma and those on placebo.
We still need to see the data in published form to be able to judge if there
were any other potential explanations for the outcome. But if the result is
unequivocal, it at least means there will be no more time and money wasted
treating patients with an ineffective therapy that carries some risks. In a
way, the negative outcome is still a step forward in sharpening treatments of
Covid-19.
The end of the pandemic may be in sight, assuming we can
control infections and the development of new variants, but it’s still many
months away. Fortunately, the more we learn, the better we know which
treatments are helpful and how to use them. The arsenal is growing. We can use
all the help we can get.
This column does not necessarily reflect the opinion of the
editorial board or Bloomberg LP and its owners.
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