TERAPÉUTICA EN CORONAVIRUS 19

HOLA BETS: Este es el estado actual de las opciones terapéuticas de la infección con COVID-19 Information on therapeutic options for patients with COVID-19 from the CDC By Denise Baez NEW YORK -- March 23, 2020 -- The Centers for Disease Control and Prevention (CDC) has released information regarding drugs that are currently being investigated in clinical trials around the world for the treatment of coronavirus disease 2019 (COVID-19). The first drug being tested is the investigational agent remdesivir, which is an intravenous drug with broad antiviral activity that inhibits viral replication through premature termination of RNA transcription and has in-vitro activity against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and in-vitro and in-vivo activity against related beta-coronaviruses. In the United States, there are 4 ways to obtain remdesivir for the treatment of hospitalised patients with COVID-19: A National Institutes of Health (NIH)-sponsored adaptive double-blinded, placebo-controlled trial comparing remdesivir with placebo is enrolling patients aged 18 years and older with COVID-19 with pneumonia and hypoxia. All patients must have oxygen saturation of ≤94% on room air or requiresupplemental oxygen or mechanical ventilation. More information on this trial can be found here. A phase 3, randomised open-label trial of remdesivir treatment for 5 days versus 10 days versus standard of care in patients aged 18 years and older with severe COVID-19, radiographic evidence of pneumonia, and oxygen saturation of ≤94% on room air. More information on this trial can be found here. A phase 3, randomised open-label trial of remdesivir treatment for 5 days versus 10 days versus standard of care in patients aged 18 years and older with moderate COVID-19, radiographic evidence of pneumonia, and oxygen saturation >94% on room air. More information on this trial can be found here. For areas without clinical trials, patients with COVID-19 in the United States and other countries have been treated with remdesivir on an uncontrolled compassionate-use basis. The manufacturer, Gilead Sciences, is currently transitioning the provision of emergency access to remdesivir from individual compassionate-use requests to an expanded access program. The expanded access program for the United States is under rapid development. Further information is available here. Hydroxychloroquine and chloroquine are also being investigated for the treatment of COVID-19. Both drugs have in-vitro activity against SARS-CoV, SARS-CoV-2, and other coronaviruses, with the CDC noting that hydroxychloroquine has relatively higher potency against SARS-CoV-2. According to the agency, a study in China reported that chloroquine had clinical and virologic benefit in patients with COVID-19, versus a comparison group, and chloroquine was added as a recommended antiviral for treatment of COVID-19 in China. The CDC said that based upon limited in-vitro and anecdotal data, chloroquine or hydroxychloroquine are currently recommended for treatment of hospitalised patients with COVID-19 in several countries. Both chloroquine and hydroxychloroquine have known safety profiles with the main concerns being cardiotoxicity (prolonged QT syndrome) with prolonged use in patients with hepatic or renal dysfunction and immunosuppression. However, the agency said both drugs have so far been well-tolerated in patients with COVID-19. Due to higher in-vitro activity against SARS-CoV-2 and its wider availability in the United States compared with chloroquine, hydroxychloroquine has been administered to hospitalised patients with COVID-19 on an uncontrolled basis in multiple countries, including in the United States. Hydroxychloroquine is currently under investigation in clinical trials for pre-exposure or post-exposure prophylaxis of SARS-CoV-2 infection, and treatment of patients with mild, moderate, and severe COVID-19. In the United States, several clinical trials of hydroxychloroquine for prophylaxis or treatment of SARS-CoV-2 infection are planned or will be enrolling soon. There are no currently available data from randomised clinical trials to inform clinical guidance on the use, dosing, or duration of hydroxychloroquine for prophylaxis or treatment of SARS-CoV-2 infection. Although optimal dosing and duration of hydroxychloroquine for treatment of COVID-19 are unknown, the CDC noted that some US clinicians have reported anecdotally different hydroxychloroquine dosing, such as 400 mg BID on day 1, then daily for 5 days; 400 mg BID on day 1, then 200 mg BID for 4 days; 600 mg BID on day 1, then 400 mg daily on days 2 to 5. Results from a recent study showed that lopinavir-ritonavir failed to significantly improve outcomes in patients with COVID-19 . However, the study was underpowered, and the combination drug is now under investigation in a World Health Organization study. At present clinical management for COVID-19 includes infection prevention and control measures and supportive care, including supplementary oxygen and mechanical ventilatory support when indicated. Reference: https://www.cdc.gov/coronavirus/2019-ncov/hcp/therapeutic-options.html SOURCE: CDC