Remdesivir is an antiviral that is given by intravenous (IV) infusion in the hospital. On October 22, 2020, the FDA approved remdesivir (Veklury) for treatment of COVID-19 in patients ages 12 and older requiring hospitalization. Remdesivir is also being studied in combination with other medications. One study reported that hospitalized COVID-19 patients who got both remdesivir and baricitinib (Olumiant) recovered about 1 day faster than those who only got remdesivir (7 days vs. 8 days). Additionally, patients had a 30% higher chance of clinical improvement at day 15 when taking both medications together. Patients who got both medications were also less likely to need ventilation or die at day 29 compared to those who only got remdesivir (23% vs. 28%). The FDA granted an EUA on November 19, 2020 for baricitinib to be used in combination with remdesivir for patients hospitalized with COVID-19 who need extra oxygen or breathing support. The NIH currently recommends using baricitinib with remdesivir only if corticosteroids (such as dexamethasone) cannot be used.
Dexamethasone is a common corticosteroid (steroid) medication that has been used for many years to treat various health conditions, such as autoimmune conditions and allergic reactions. RECOVERY, a randomized clinical trial in the UK, is studying many medications, including dexamethasone, to see if any are effective against COVID-19.
Researchers found that there was a lower death rate at day 28 in the 2,104 hospitalized patients with COVID-19 who got a low, daily dose of dexamethasone (either by mouth or IV injection) compared to the 4,321 patients who did not get it (23% versus 26%, respectively). This difference was significant. The medication seemed to be most helpful for patients who were on a ventilator or needed extra oxygen. There was no benefit for those with less severe symptoms.
On March 24, 2020, the FDA issued an Emergency Investigational New Drug (eIND) application for the use of convalescent plasma to treat people with COVID-19. Plasma is the liquid part of blood that carries blood cells. Convalescent plasma is collected from people who have recovered from COVID-19. It is then transfused into someone with an active coronavirus infection. It is thought that antibodies found in the convalescent plasma can help fight the coronavirus infection.
On August 23, 2020, the FDA issued an emergency use authorization (EUA) for convalescent plasma for hospitalized patients with COVID-19. (This decision was a reversal from a previous decision to put it on hold due to a lack of convincing evidence.) This does not mean convalescent plasma has been approved or proven as a treatment for COVID-19, but it does make it easier for providers to get convalescent plasma in case they think it’s worth trying. At day 7, the death rate was lower for the group who got convalescent plasma within 3 days of diagnosis compared to the group who got it after 4 or more days. There was no control group (i.e., patients who did not receive any convalescent plasma) to compare this to, so it’s unclear if he difference in death rates was actually because of the treatment or other factors. Death rates were also lower in patients who got convalescent plasma with higher antibody levels compared to plasma with lower antibody levels.
Monoclonal antibodies (MABs)
Antibodies proteins made by the immune system to help fight infections. They bind to foreign pathogens, like viruses, and help destroy them. Monoclonal antibodies (MBAs) are antibodies made in a lab. It can take the body weeks to develop natural antibodies, so using MABs can potentially fight off infections sooner.
Eli Lilly and Regeneron are two companies that both have MABs in development for COVID-19, currently called bamlanivimab (LY-CoV555) and REGN-COV2, respectively. Both companies filed EUAs for their therapies in early October, and the FDA issued EUAs for both medications in November. AstraZeneca is also starting studies on a long-acting antibody combination called AZD7442. Other MABs in the pipeline include VIR-7831 and the combination BRII-196 and BRII-198.