British doctors hope that a drug they are now testing will prove beneficial for COVID-19. The medication is an inhaled version of interferon beta, a compound that the body makes in reaction to viral infections. Researchers have also been looking at other old drugs to fight COVID-19. Initial results are somewhat encouraging.
Interferon Beta:
The pilot study of interferon beta (SNG001) was small, involving only about 100 patients. But it was a double-blind trial. When interferon beta was administered by nebulizer it reduced the likelihood that severely ill patients would require ventilators. They were also able to leave the hospital sooner. Larger, more thorough trials will be necessary to determine whether the initial positive results will hold up.
The company is Synairgen and is registered in England and Wales. The offices are in the Southampton General Hospital. The principal investigators and founders are professors at the University of Southampton, UK.
This experimental compound is not yet available commercially. But there are a number of established drug companies that are already marketing interferon beta for the treatment of multiple sclerosis.
Whether those forms of interferon beta could be used or would work to fight COVID-19 will need to be determined. It may be that only the Synairgen formulation is appropriate for use in the lungs and will work against SARS-CoV-2. We look forward to more data and bigger trials to determine the true effectiveness of this compound.
Dexamethasone to Fight COVId-19:
Another drug drawing attention is the corticosteroid dexamethasone. The RECOVERY trial from the University of Oxford has confirmed preliminary findings that this drug saves lives when COVID patients are extremely ill (New England Journal of Medicine, July 17, 2020).
Over 2000 patients received dexamethasone while 4321 patients received usual care. The investigators conclude:
“In patients hospitalized with COVID-19, the use of dexamethasone resulted in lower 28-day mortality among those who were receiving either invasive mechanical ventilation or oxygen alone at randomization, but not among those receiving no respiratory support.”
“Dexamethasone is on the list of essential medicines of the World Health Organization and is readily available worldwide at low cost. Guidelines issued by the U.K. chief medical officers and by the National Institutes of Health in the United States have already been updated to recommend the use of glucocorticoids in patients hospitalized with Covid-19.”
An infectious disease expert at the University of Oxford, Dr. Peter Horby, offers this perspective:
“The survival benefit is clear and large in those patients who are sick enough to require oxygen treatment, so dexamethasone should now become standard of care in these patients.”
Heparin to Fight COVID-19:
Heparin is a powerful anticoagulant that was discovered over a century ago. Clinical trials began in the 1930s to determine if the drug could prevent blood clot formation. Today, heparin is an essential medicine in every hospital in the country.
Researchers have discovered that this old blood thinner attaches firmly to the spike protein found on the SARS-CoV-2 virus. This surprising action might interfere with the ability of the virus to cause infection.
Scientists are calling heparin a potential decoy for SARS-CoV-2. In other words, the virus might bind to heparin instead of the ACE2 receptor on cells (bioRxiv, July 14, 2020). The authors conclude:
“Manipulation of heparin sulfate or inhibition of viral adhesion by exogenous heparin may represent new therapeutic opportunities.”
An article in Critical Care (July 22, 2020) https://pubmed.ncbi.nlm.nih.gov/32698853/ adds this perspective on the potential for heparin to fight COVID-19:
“Nebulised unfractionated heparan (UFH) has a strong scientific and biological rationale and warrants urgent investigation of its therapeutic potential, for COVID-19-induced acute respiratory distress syndrome (ARDS).
“…Trials in patients with acute lung injury and related conditions found inhaled UFH reduced pulmonary dead space, coagulation activation, microvascular thrombosis and clinical deterioration, resulting in increased time free of ventilatory support. In addition, UFH has anti-inflammatory, mucolytic and anti-viral properties and, specifically, has been shown to inactivate the SARS-CoV-2 virus and prevent its entry into mammalian cells, thereby inhibiting pulmonary infection by SARS-CoV-2.
“…UFH is widely available and inexpensive, which may make this treatment also accessible for low- and middle-income countries. These potentially important therapeutic properties of nebulised UFH underline the need for expedited large-scale clinical trials to test its potential to reduce mortality in COVID-19 patients.”
Ivermectin to Fight COVID-19:
We have long thought that ivermectin was one of the more interesting drugs of the last few decades. It was originally approved to treat parasites in animals in 1981. Perhaps you recognize the name Heartgard. It is used to prevent dogs from getting heartworms.
Then ivermectin was found to treat river blindness (onchocerciasis). It has made a huge difference for millions of people in Africa. But wait, there’s more. Ivermectin has been shown to work against a number of other parasites. It can also kill the mites that cause scabies and head lice.
To our surprise, there are data to suggest that ivermectin may also have antiviral activity. A letter to the editor of the Brazilian Journal of Infectious Diseases (June 28, 2020) suggests:
“The in vitro potency of ivermectin against Covid-19 virus is a testimony that this drug can be utilized to manage those patients who have been infected with SARS-CoV-2. Since the conditions in which the virus replicates and infects the cells in vivo and in vitro differs, a decisive comment about how ivermectin may prove to be beneficial to the patients cannot be constructed yet.”
“…Nevertheless if compared with the other pharmacotherapeutic options for the management of Covid-19 infection, ivermectin may prove to have leverage over them.
“…it becomes imperative that clinical trials with ivermectin be conducted in patients of Covid-19, to comprehend whether this drug can provide beneficial effect to those patients who have already developed complications due to this infection.”
No one should self-medicate with ivermectin. We need clinical trials before anyone is given this medication. But it is an interesting compound and we hope randomized controlled trials will soon follow.
Final Words:
We are all awaiting safe and effective vaccines against COVID-19. In the meantime, we hope that researchers are looking for effective therapeutic agents. Old drugs that have been approved for other uses may also fight COVID-19. The sooner we can learn about the benefits and the risks of such drugs the better.
