Current Most Used Coronavirus Treatments

Credits: Royalty free picture from Unsplash

Content updated to March 25th 2020:

Virus blockers

2. Vaccines

3. HIV related antiretrovirals

4. Antiarthritis based treatment

5. Highdose intravenous vitamin C, really?

6. References & Contacts

The people infected by Corona virus (COVID19) are currently 460.000, with a serious impact on the economy and heavily challenging the healthcare system of several countries. In some countries curfew regimes are curbing the outbreaks, but there is a high risk of pandemics. I am a scientist, I am NOT a virologist, I do not have access to intensive care unit (ICU), or a BSL-2/4 biology lab for testing, but I have seen even experienced doctors asking for suggestions of colleagues. I hope this survey might give insights to people even more experts than me, I tried to write in a language accessible to both experts and laymen. Do not take this as an official guideline, but for possible insights. I also decleare no conflict of interest with the mentioned companies. I report at the bottom the contacts for the mentioned treatments, for further infos.

At the moment there is NO confirmed treatement, but there are more than 70 drugs currently tested, mostly coming from past Ebola, HIV and SARS experiences. I report here the most popular which are currently investigated. For the unaccostumed reader there are 4 phases of clinical trials before a drug is approved. In parallel, FDA has released a warning to several companies selling fraudulent cures (mostly esssential oils).

1. Virus blockers

Remdesivir (Stage: Phase 3)

The most advertised is for sure Remdesivir, produced by Gilead Sciences Inc. (USA), currently in phase 3 clinical trial for COV19. It is an antiviral drug in the class of nucleotide analogs.

Many people are optimistic about the clinical trial, the drug «confounds the virus» by creating a misshapen version of nucleotides that are needed by the virus to self-replicate. This approach is called nucleotide analog, i.e. it mimics a genetic building block which are necessary but leading to its failure. It has shown promising results in mice, rhesus monkeys, Ebola and MERS patients.

We are currently waiting for the blinded study to have further confirmation. Blinded study means that some patients will receive the treatment and other only a placebo. It is currently in phase 3, which requires about 1000 patients, the further steps are phase 4, and commercialization if phase 3 and 4 are passed.

Click here to see is Gilead official announcement of the clinical trial

Physicians are also investigating to combine it with Eculizumab (Soliris) to calm down the cytokine storm in lungs, or Sariluman, Tocilizumab (IL-6 blocker), in case of overreaction of the immune system. See Section 4 about this.

Chloroquine phosphate (Stage: preclinical)

In in-vitro experiments this old anti-malaria drug showed being even more effective than Remdesivir. This is however yet to be officially shown in humans. A clinical trial is currently in recruiting phase, you can find more info here.

Preliminary results in China, unfortunately, seem lukewarming the enthusiam as reported in the article “A pilot study of hydroxychloroquine in treatment of patients with common coronavirus disease-19 (COVID-19)”.

Nevertheless, if instead proved successful in larger populations, this will be a great news as large supplies of Chloroquine phosphate are already available. Bayer produced it with the brand name of Resochin, and declared it has already shipped 300,000 tablets of Resochin to Guangdong provincial government. The good news is that many generic versions already exist.

A typical treatment protocol would look like the following, which has been attributed to the CDC Global Rapid Response Team. I have transcripted it here from scans and pictures circulating online:

The adviced protocol from CDC for diagnosis can be found here.

2. Vaccines

Vaccines are the long run solutions as they take long time to be approved in clinical trials on large populations (even longer than treatment generally). Vaccines are generally created by weakened version of viruses. Nevertheless, we have a series of previous studies on SARS and MERS, despite they were no longer investigated as SARS and MERS stopped spreading.

MRNA-1273 (Stage: phase 1)

Moderna Therapeutics has developed mRNA-1273 with the novel approach of injecting short pieces of genetic material from COV19 directly into people’s bodies.

CureVac (Stage: preclinical)

Like Moderna Therapeutics, CureVac vaccine is based on mRNA fragments to promote proteins and subsequent protection.

Sanofi (Stage: preclinical)

Sanofi is developing a «chimera» vaccine mixing some COVID19 DNA with genetic material from a harmless virus to humans, and instructing the immune system of healthy individuals. On a press release, Sanofi declared that the vaccine could be ready to test a vaccine in people within a year to 18 months.

TAK-888 & Plasma from survivors (Stage: preclinical)

Chinese doctors are using plasma therapy on coronavirus, and WHO says it is a ‘very valid’ approach. If a person is infected by the virus and survives, his/her blood is full of powerful antibodies. Collecting blood plasma from survivors and infusing it into another patients can sometimes be life-saving. Already Chines clinics have set up a special unit to administer plasma therapy.

The Japanese company Takeda has already made a medicine called intravenous immunoglobin, or IVIG, for treating patients who have immune disorders. With a variation of it called TAK-888, Takeda aims at creating an IVIG from survivors blood.

3. HIV related drugs

Some HIV drugs are often used to block key enzymes that helps viruses replicate. Despite this has not been specifically proved for Corona virus, Combinations of Lopinavir and Ritonavir (antiretroviral for HIV) showed promising results in 52 patients .

The company Abbvie produces this combination with the brand name of Kaletra (also marketed as Aluvia). AbbVie has donated $1.4 million of Kaletra supply to Chinese authorities with the hope of testing the effectiveness.

Similarly Johnson & Johnsons shipped supplies to China of its HIV drug Prezcobix for potential treatment of coronavirus infection.

4. Anti-arthritis based treatment

At first sight there is no relationship between arthritis and COVID19. When certain infections (as the COVID19) occur, collateral damages can be introduced by the immune system of the person which is sending too many pro-inflammatory signals. If too many pro-inflammatory cytokines, as one called interleukin-6 (IL-6), are released, a “cytokine storm” can start and be life threatening, even more than the virus itself. In this circumstance, drugs developed to treat arthritis can be used to slow down the immune system during the fight of COVID19 calming down the “storm”. According to reports, 14 critically ill patients treated with Actemra (and anti-arthritis drug from Roche) showed positive results after treatment at hospital affiliated with the University of Science and Technology of China (USTC). Currently, there is no available data on drug safety or efficacy. Other anti-inflamatory drugs were mentioned in Section 1.

5. High dose intravenous vitamin C, really?

As mentioned in the previous section, COVID19 seems mostly a lung injury stemming an hyperactivation immune effector cells. Hence, high-dose intravenous vitamin C could acts as immunosuppression of these effectors. This is probably the most controverial of the ideas, which is rising some criticisms about its validity. Nevertheless, a clinical trial on this is also runnig. However, this approach should not be confused with taking simple supplements of vitaminc C.