With coronavirus cases on the rise throughout Europe, but already millions of people vaccinated and a good “hold” with regard to hospitalizations (which do not rise as decisively), the hypothesis of accept a forced coexistence with the virus. To return to life as before without abandoning caution, the winning weapon is to vaccinate, but it is not the only one. There are now some very effective drugs which can be used against the risk of hospitalization and, in case of hospitalization, help to heal.
What protocols exist for anti Covid treatments?
More than protocols, we speak of “recommendations” by the Italian Medicines Agency (Aifa) and the Ministry of Health. The latest update by the Ministry regarding home care dates back to April and includes a series of case studies with the list of possible options. It is these days, however, the release of a joint document between the Italian Society of General Medicine (SIMG) and the Italian Society of Infectious and Tropical Diseases (SIMIT) which takes stock of existing drugs. The real breakthrough in home management is represented by monoclonal antibodies against the Spike protein, which are the only specific and effective antiviral treatment against SARS-CoV-2.
What medications are recommended for a minor illness?
«The only intervention is the therapies against symptoms, therefore paracetamol for fever and NSAIDs for musculoskeletal pain – explains Gianluca Trifirò, Full Professor of Pharmacology at the University of Verona -, in addition to monitoring saturation. Monoclonals can be considered in the early stages of symptomatic infection for fragile or high-risk patients (diabetics, heart patients, very elderly people) in home management: it is the family doctor who must in fact identify the subject to be treated and send it promptly to the hospital reference. These drugs are administered by infusion in dedicated clinics ».
When are they used and what benefits do monoclonals bring?
“They are the only drugs that have demonstrated an antiviral action, especially useful in the very early stages, within the first 3-4 days from the possible onset of mild / moderate clinical symptoms – clarifies the expert -. In terms of viremia reduction they are all effective, especially compared to many other drugs already on the market tested as antivirals against SARS-COV2 which over time have proved useless, if not even harmful. They are antibodies that bind to the Spike protein and prevent the entry into the cells and, therefore, the replication of the virus. To date they are safe, very effective and require only one infusion ». According to the first studies, the monoclonals in use are also effective against the Delta variant.
Are they authorized in Italy?
They have emergency authorization and, similar to vaccines that have received conditional approval, a reassessment of their benefit-risk profile is contemplated on the basis of new data generated after their marketing. In Italy there are over 6,100 Covid patients who have received them from 10 March to the end of June. Most of these were treated with Eli Lilly’s combination of bamlanivimab and etesevimab, followed by Regeneron-Roche’s combination casirivimab and imdevimab. On June 17, tocilizumab (for the treatment of hospitalized adults with severe Covid and / or with high levels of systemic inflammation indices, in rapidly worsening clinical conditions was added to the list of drugs reimbursable by the Health Service even if not authorized ). This monoclonal antibody, already authorized for the treatment of rheumatoid arthritis, has just been included by the World Health Organization (WHO) in the guidelines for anti Covid treatments.
What is used on serious and severe cases in the hospital?
«Especially in those patients who go to desaturate, it has been seen that cortisone, in particular dexamethasone, has a great efficacy, which has shown exceptional results in terms of reducing mortality. Heparin is often associated, but as a prophylactic therapy, in patients who have pneumonia and are immobilized. Other drugs with an anti-inflammatory and immunosuppressive action have proved useful, such as tocilizumab, but it is to be reserved only for a certain category of patients and in addition to cortisone “, explains Trifirò.
Compared to the first tragic wave, how many people can we save in the hospital?
“With cortisone in intensive care we really have the possibility of almost halving the risk of mortality compared to the first periods – says the specialist -. The important thing is also to prevent access to hospital for fragile patients, at higher risk of mortality, and for this reason monoclonal antibodies are very useful ».
Do vaccinated people need to be treated the same way?
“In principle, yes,” says Trifirò. “Vaccinated patients do not undergo serious Covid, except in extremely limited cases and usually they are fragile people”.
Are other drugs on the way this fall that could help us?
We may have four (if not more) monoclonal antibodies to Spike protein available by the end of the year, such as Eli Lilly’s combination of bamlanivimab and etesevimab and Regeneron-Roche’s combination of casirivimab and imdevimab, which are already authorized in Europe. for emergency use, and regdanivimab from Celltrion and sotrovimab from GlaxoSmithKline-Vir Biotechnology, under review by EMA; in addition, there are many expectations of immunosuppressants already on the market for the treatment of rheumatoid arthritis, such as baricitinib and tofacitinib.