COVID-19 Solutions- Without The BULL
August 8, 2020 COVID-19 SOLUTIONS WEEKLY UPDATE
Treatment choices for Covid-19 continue to evolve. When the pandemic first hit New York and New Jersey, the hospitals were overwhelmed and treatments not clear. Dialysis machines, ventilators, PPEs were in short supply. Many patients and health care workers died or suffered because of lack of preparedness.
5 months after the initial trials with hydroxychloroquine, azithromycin, tocilizumab, Remdesevir, Ritonavir/lopinavir, steroids, imervectin, Leronlimab, convalescent plasma, patterns have begun to emerge.
Onvalscent plasma seems to be helping although initial trials were either unsuccessful or partially successful. Oxygen and steroids help although there is still concern in using steroids in critically ill Covid-19 due to immune suppression. Remdesevir appears to help in mild to moderate patients, although most of them do well. It may have mortality benefit but that has not been shown yet. Leronlimab suggested benefit in the initial study set. Leronlimab’s trial in 86 patients with mild to moderate disease suggests that they did not achieve significance in their secondary end points and perhaps only in one parameter called NEWS2. The Data and Safety monitoring committee response to Leronlimab’s trial in severe to critically ill patients suggests that side effect profile is good but that there was not an overwhelming evidence in favor of the drug suggesting it is somewhere in between 20% and 80% mortality benefit perhaps closer to 40%.
Other drugs being tested currently in different protocols include ivermectin, an anti-parasite drug which had shown evidence of preventing SARS-Cov2 replication in the lab and then studies elsewhere including Bangladesh suggested benefit in Covid-19. Ivermectin trials have been slow in recruiting in the US so most trials are currently outside the US; baricitinib in the US; Tocilizumab in combination with remdesevir, favipiravir, convalescent plasma, Lenzilumab for cytokine storm, and many others. More recently, Itolizumab, an anti-CD6 molecule, showed very good mortality benefit in a small trial in India when compared to placebo. Further trials are pending.
Recently, at the Methodist Hospital in Houston, avipitadil, showed initial promise in improving mortality rates in severe to critically ill patients. Aviptadil has a phase III ongoing randomized control trial of 144 patients in severe to critically ill patients. While it is clear that no single drug will be the silver bullet, a combination of one or more drugs seems the way forward perhaps including convalescent plasma until such time that synthetic antibodies emerge. The data on hydroxychloroquine is so conflicting that it would take a group of non-partial scientists to sort that out.
UMANG KHETARPAL, M.D.
Dr. Umang Khetarpal finished his medical school at the young age of 22 and is trained in Otolaryngology-Head and Neck and Facial Plastic Surgery. He completed his internship and specialty residency training in Syracuse, New York. He also has extensive research experience and additional clinical experience through fellowships at Massachusetts Eye and Ear Infirmary and Brigham and Women’s Hospital, Harvard Medical School in Boston. He has co-authored book chapters and many publications in peer reviewed journals within the specialty. He has presented at major specialty society meetings and at academic institutions. Topics of his research included hearing loss and balance disorders, sinus problems and sleep apnea. His recent research efforts have been entirely focused on sinusitis, especially recurrent acute rhinosinusitis, allergies and in office balloon sinuplasty and in office sinus surgery. He has recently presented five papers at the International meeting of Rhinology in CHicago, June 2019. He discovered and was the first to describe a novel ear disease in families that resulted in balance and hearing problems. His most innovative research was in the cutting-edge field of genetics in Otolaryngology where he was involved in finding the genetic defects for several different diseases. In addition, he has taken time to observe the surgical techniques of some of the world’s most renowned surgeons in plastics surgery. He had been featured 3 times over the years in newspapers in the Rio Grande Valley for introducing latest treatments in thyroid cancer, sleep apnea and sinus surgery locally. His current interest is in molecular genetics of allergic rhinitis and chronic sinusitis with and without polyps and in finding better cures for these conditions. He now calls Houston his home and is starting his practice in the Woodlands.