By Christine Westerhaus

In addition to vaccinations, will corona medications soon be useful as well? (imago / Ikon Images / Gary Waters)

Initially, antiviral drugs such as Remdesivir are used to treat Covid patients. But they don’t help everyone. The WHO is currently testing three drugs that take a different approach: They are believed to slow the overreaction of the immune system.

When data from the “Recovery” study was released in June 2020, the World Health Organization spoke of a breakthrough. Dexamethasone can help critically ill Covid patients, the study from Britain showed. That was reason enough for UK Prime Minister Boris Johnson to devote a separate press conference to drugs.

“I am proud of these British scientists who have shown in the world’s first robust clinical study that dexamethasone reduces the risk of death in Covid patients. “

Problem: excessive immune reactions

Dexamethasone acts like the hormone cortisone and is actually a medicine for rheumatoid arthritis or asthma. In the case of these diseases, similar to a severe course of Covid-19, there is an overreaction of the immune system. And dexamethasone helps alleviate this exaggerated attack. Doctors are now also using tocilucimab in Covid patients. This substance also slows down the body’s defensive reactions and is usually prescribed for patients with rheumatism.

But although intensive care physicians now have options for treating critically ill Covid patients, there is still a need for new drugs, says intensive care physician Anthony Gordon. He is a professor at Imperial College London and has himself been involved in clinical studies of Covid drugs.

“The study results are very good, both drugs save lives. But there are still people for whom they don’t work. A quarter of all Covid patients still die in intensive care units. It certainly can be. even better. “

“Solidarity trial”: global search for drugs against Covid-19

After four candidates had been tested unsuccessfully in the meantime, the World Health Organization therefore continued the so-called “Solidarity Trial” in early August. A kind of globally coordinated research into treatment methods for Covid patients. Three new drugs are targeted in this study. They have all been used for a long time against other diseases. Infliximab for rheumatoid arthritis and inflammatory bowel disease. Imatinib for cancer and artesunate for malaria. But even though the drugs are used for such different diseases, they have one thing in common, says John-Arne Røttingen, representative for global health at the Norwegian Ministry of Foreign Affairs and responsible for the Solidarity study:

“All three candidates are so-called immunomodulators. They are directed against reactions of the immune system, so they are not virus-killing agents. Most studies have shown that antiviral drugs no longer help Covid patients. when hospitalized with severe symptoms. “

Block individual immune reactions

At the start of the pandemic, doctors placed their hopes in remdesivir, a virus-killing drug that was originally developed against the Ebola virus. But clinical studies have shown: Remdesivir cannot save the lives of critically ill Covid patients. There is now a consensus among doctors: in the event of severe changes in Covid, the body’s own defense should be slowed down. They therefore rely on drugs that block individual reactions of the immune system. Like artesunate, a drug that has been used for a long time against malaria.

“It may seem strange that we want to test a drug against malaria. But artesunate prevents inflammatory cells from migrating into the lungs – which is an important part of a serious disease process,” says Røttingen.

“Although there is no clinical data yet, i.e. experience with Covid-19 patients. But artesunate is available and inexpensive all over the world. Therefore, from a global health perspective, it is important to test the potential of this drug. “

Not enough clinical data yet

There is already some evidence that the other two candidates, infliximab and imatinib, can help critically ill Covid patients. However, they are significantly more expensive than artesunate. Covid infection is often harmless in people who take infliximab for rheumatic diseases. And the cancer drug Imatinib has already proven to work, says John-Arne Røttingen.

“We believe that imatinib can protect the small blood vessels in the lungs and therefore prevent them from being damaged. It improves the transport of oxygen from the lungs to the blood vessels. A small study from the Netherlands gave promising results. But it was generally closed small, so it’s important to test imatinib in a large clinical trial now. “

Doctors are currently recruiting patients for their clinical exams. John-Arne Røttingen does not expect the first results until early next year. Critical care doctor Anthony Gordon is optimistic the new drugs will help save more lives. Because one thing is certain: the corona virus will continue to infect people. Corn:

“We can now treat this disease much better than 12 or 15 months ago. About a quarter of patients die in intensive care units. At first it was half. This shows the progress we have made through clinical studies. And “it is important that we move forward and continue to tackle this devastating disease.”