Since the outbreak of the new crown pneumonia epidemic, in the treatment of patients with new crown pneumonia, countries have combined their own actual conditions and past experience, each with their own unique strategies and unique characteristics. Vaccines and specific drugs against this virus are the hope of mankind to overcome the new crown epidemic, and its research and development progress affects the nerves of hundreds of millions of people around the world. As of early June, my country has already entered clinical trials of six new coronavirus vaccines, and it is believed that they will be available in the near future. Before that, some “special effects drugs” became the focus of attention. Can these so-called “special effects drugs” withstand clinical verification? Is there really a specific medicine for the treatment of the new coronavirus? Now, let us sort it out together.
The few “special effects” reported so far are mainly the following 3 kinds:
1. Lopinavir ritonavir tablets (Klitsch)
Kelizhi entered the public eye and attracted attention because of Wang Guangfa, director of the Respiratory Department of Peking University First Hospital. He is also a member of the expert group for pneumonia caused by the novel coronavirus, and he has traveled to the front line of Wuhan with the expert group of the National Health Commission. After returning to Beijing, he was diagnosed with the new coronavirus. In an interview with the media, he stated that he had taken lopinavir and ritonavir tablets during the treatment, and his body temperature dropped after one day of taking the drug.
Lopinavir Ritonavir Tablets is an anti-HIV drug, which is a compound preparation of Lopinavir and Ritonavir. Studies have found that lopinavir can inhibit the SARS-CoV main protease Mpro. During the SARS epidemic in 2003, scholars in Hong Kong, China discovered that lopinavir and ritonavir compound preparations can reduce the incidence of acute respiratory distress syndrome and Case fatality rate. As for the new coronavirus, a rapid systematic review pointed out that Kelizi has a good effect in the early treatment of new infections, and it may increase the mortality rate in the late stage.
In general, the evidence-based evidence for Kelizi’s use in the treatment of new coronary pneumonia is still insufficient, and the drug is prone to gastrointestinal adverse reactions and liver damage, with relatively large side effects. Therefore, although the drug is listed in the “Diagnosis and Treatment Plan for Pneumonia Infected by New Coronavirus (Trial Seventh Edition)”, according to information from the Chinese Clinical Trial Registry, it is still in randomized controlled trials and there is no conclusion.
Remdesivir was first applied to a patient with COVID-19 in the United States. The patient’s clinical symptoms were significantly improved on the second day after using the drug, with reduced fever, reduced cough, and improved lung function. Subsequent articles published in the world’s top medical journal “The Lancet” showed that the drug can inhibit viral RNA-dependent RNA polymerase, and can inhibit viral intracellular replication at lower concentrations. A number of in vitro studies have shown that Remdesivir has an inhibitory effect on a variety of human and animal coronaviruses. Due to the 2019 novel coronavirus (2019-nCoV) genome and clinical manifestations of the infected person, it is related to SARS-CoV and Middle East Respiratory Syndrome Signs of coronavirus (MERSCoV) are similar, so it is speculated that Redecive may be effective against 2019-nCoV.
Remdesivir’s domestic situation does not seem to be optimistic. On February 6, Remdesivir started a clinical trial in Wuhan Jinyintan Hospital. According to media reports on April 15th, the clinical study of Redecive in China for patients with mild and common COVID-19 (new coronary pneumonia) was suspended due to the “low enrollment rate”. Earlier, the clinical trial of Redecive in China for patients with severe COVID-19 has also terminated the study.
However, the situation of Remdesivir abroad is completely different. As a “star player” Remdesivir has obtained special approval from the US Food and Drug Administration (FDA) and is currently in clinical trials. On April 10, the world-renowned journal “New England Journal of Medicine” published a sympathy drug for remdesivir (sympathetic medication is also called expanded use. The core content is to allow some non-approved clinical conditions, but no drugs Rescuable terminal patients, using drugs or medical devices that have not yet been approved for marketing in institutions where clinical trials are conducted) retrospective analysis and research results, including 53 patients with severe new coronary pneumonia from the United States, Japan, Canada and Europe Among them, 68% of patients improved in the type of oxygen support, and 7 patients (13%) died. At the same time, 60% of adverse reactions were observed in the study, and some were serious adverse reactions. In this regard, my country’s well-known expert Professor Cao Bin believes that the results of this study do not constitute an effective proof of the efficacy of Redecivir, and we look forward to the release of more randomized double-blind controlled clinical trials.
Chloroquine has a long history of application in my country. It was first widely used in the treatment of malaria and autoimmune diseases. In recent years, it has also been regarded as a potential broad-spectrum antiviral drug. It also has immunomodulatory activity and can synergistically enhance its antiviral effect.
On February 4, a study published in the world-renowned magazine “Cell Research” showed that in vitro cell experiments, in addition to remdesivir, chloroquine phosphate is equally effective in inhibiting the new coronavirus. US President Trump also posted on his social media that chloroquine combined with azithromycin can be used to treat new coronary pneumonia, and my country’s “New Coronavirus Infection Pneumonia Diagnosis and Treatment Plan (Trial Sixth Edition)” has also been included in clinical guidelines. Academician Zhong Nanshan said that although chloroquine phosphate is not enough for a specific drug, it is worth exploring.
However, according to an observational study published in the New England Journal of Medicine on May 7, hydroxychloroquine does not seem to help hospitalized patients suffering from COVID-19. Researchers found that nearly 60% of patients took hydroxychloroquine within 48 hours of hospitalization, but their average condition was more serious than those who did not take the medication. At the same time, the side effects of the heart caused by chloroquine/hydroxychloroquine combined with azithromycin are getting more and more attention. On the afternoon of May 26, the Director-General of the World Health Organization Tan Desai announced that the WHO has suspended the testing of hydroxychloroquine in clinical trials, and the Data Security Testing Committee will further study the relevant safety data of hydroxychloroquine. On June 3, the World Health Organization announced the resumption of the hydroxychloroquine trial; subsequently, the World Health Organization issued a statement on June 17 stating that hydroxychloroquine cannot reduce the mortality of hospitalized patients with new crowns, so it will stop hydroxychloroquine in the “Solidarity Trial Project”. Experimental study of chloroquine. What will change in the future is still unknown.
In addition to the three drugs mentioned above, fabiravir, arbidol, darunavir and other drugs are also undergoing clinical trials intensively, and their efficacy requires more clinical trial data to support. Many Chinese medicines have been reported in the prevention and control of this epidemic, but most of them still lack evidence-based medical evidence to confirm that Chinese medicines have specific anti-coronavirus effects, and further research is needed.
Although the current antiviral drugs are not very effective, in fact, China has also achieved staged results in the fight against the epidemic. This is mainly due to the scientific and strict measures taken by China from the three elements of the transmission of infectious diseases. The specific method is to focus on the treatment of infections. People, cut off the route of transmission, and protect susceptible people. The world’s top magazine “Nature” once published a paper praising my country’s anti-epidemic achievements. The paper pointed out that if strong non-pharmaceutical interventions were not taken, my country’s new crown cases may increase by 67 times to more than 7 million. At least from the analysis of the current epidemic prevention and control situation, these non-drug interventions are more effective than current non-specific antiviral drugs.
In short, the research and development of new drugs is a complicated and long process. The reason for this is that a large number of clinical trials are required from research and development to market, which is often one in a thousand or one in a thousand. Therefore, there is currently no specific medicine for the treatment of the new coronavirus. What we can do is to protect ourselves, strengthen nutrition and rest, improve our immunity, and avoid unnecessary gatherings of people, especially indoor activities, to avoid cross-infection and protect the elderly. People, take an orderly, positive and conditional resumption of work and production until the end of the epidemic.