Remdesivir, dexamethasone and baricitinib represent the best therapeutic approaches for Covid-19 and have helped reduce viral loads, decrease inflammation and ease symptoms in hospitalised patients.
By Tharanya Arumugam - July 26, 2021 @ 9:40am
New Straits Times
Medical frontliners arriving at the Covid-19 Assessment Centre at Malawati Stadium in Shah Alam on Saturday. -NSTP/ASYRAF HAMZAH
KUALA LUMPUR: Remdesivir, dexamethasone and baricitinib represent the best therapeutic approaches for Covid-19 and have helped reduce viral loads, decrease inflammation and ease symptoms in hospitalised patients.
Public health medicine specialist Associate Professor Dr Rafdzah Ahmad Zaki of University Malaya Medical Centre said remdesivir (an anti-viral agent that scientists initially designed to treat Ebola) and dexamethasone (an anti-inflammatory medication) were considered the best available treatment options for Covid-19 pneumonia.
"Remdesivir is likely to be most effective in the early stage of pneumonia, whereas dexamethasone is likely to be most effective later in the disease's course.
"Baricitinib hopes to fill the gap or unmet need of providing efficacious therapies for the grey zone between remdesivir and dexamethasone," she told the New Straits Times.
Health director-general Tan Sri Dr Noor Hisham Abdullah had on July 23 said health facilities would start administering baricitinib to Covid-19 patients, especially those in categories four and five (patients with lung infections and require oxygen or ventilators).
Category one patients are asymptomatic, while those in Category two display mild symptoms. Category three patients suffer from pneumonia and lung infection.
Dr Noor Hisham had said baricitinib, also a drug approved for use in patients with moderate to severe arthritis who have had an inadequate response to other treatments, had been proven to be more effective in treating infected patients, along with dexamethasone.
Dr Rafdzah, who is head of the Centre for Epidemiology and Evidence-Based Practice, Department of Social and Preventive Medicine, Faculty of Medicine, said two main processes were thought to drive Covid-19's pathogenesis.
She said that early in the clinical course, the disease was primarily driven by the replication of the SARS-CoV-2 virus, while later in the clinical course, it appeared to be driven by a dysregulated immune/inflammatory response to the virus that led to tissue damage.
"Based on this understanding, it is anticipated that therapies that directly target SARS-CoV-2 would have the greatest effect early in the course of the disease, while immune-suppressive/anti-inflammatory therapies are likely to be more beneficial in the later stages of Covid-19.
"Baricitinib is a drug that reduces the activity of the immune system. As an anti-inflammatory, it may block the signalling activity that can contribute to the hyper-inflammatory state caused by a severe Covid-19 infection."
Dr Rafdzah said besides Malaysia, the United States' National Institutes of Health and Singapore's National Centre for Infectious Diseases had recently included baricitinib in their treatment guidelines for Covid-19.
Japan had approved the use of the rheumatoid drug for treating Covid-19 patients.
"The use of baricitinib together with remdesivir have been found to be superior to remdesivir alone in reducing recovery time and accelerating improvement in clinical status among Covid-19 patients, especially among those receiving high-flow oxygen or non-invasive ventilation.
"The combination of baricitinib and remdesivir is associated with fewer serious adverse events."
On calls for ivermectin to be included as part of the country's list of treatments for Covid-19, Dr Rafdzah said the evidence on the use of the drug to treat Covid-19 patients was inconclusive.
Most studies looking at ivermectin and Covid-19 had incomplete information and significant methodological limitations and bias, she said.
"Some of the limitations include the sample size of most of the trials, which was small, and some of the randomised controlled trials were open-label studies, where neither the participants nor the investigators were blinded to the treatment arms.
"Besides, patients received various concomitant medications (for example, doxycycline, hydroxychloroquine, and corticosteroids) in addition to ivermectin or the comparator drug. This confounded the assessment of the efficacy or safety of ivermectin.
"The severity of Covid-19 among the study participants was not always well described, and the study outcome measures were not always clearly defined. Therefore, until more data is available, the drug is only approved to be used within clinical trials."
She added that the US Food and Drug Administration had not approved ivermectin for use in treating or preventing Covid-19 in humans.
"Ivermectin tablets are approved at very specific doses for some parasitic worms, and there are also topical (on the skin) formulations for head lice and skin.
"Ivermectin is not an anti-viral (a drug for treating viruses). Taking large doses of this drug is dangerous."
Epidemiologist and biostatistician Professor Dr Jamalludin Ab Rahman from International Islamic University Malaysia said doctors should not rush to administer ivermectin, but instead wait until the clinical trials conducted by the Health Ministry were completed.
"Most countries are not using ivermectin. This pandemic is testing many so-called scientists and experts.
"We should be patient and go back to the fundamentals of evidence-based medicine.
"This practice is confusing the public because even experts can't agree on certain standards and are still citing conspiracies.
"I praise the ministry for sharing the data on Covid-19 recently, which is an important progress in battling the pandemic.
"Now, many epidemiologists, statisticians and data scientists, locally or abroad, are looking for trends and any information that can assist the government."
ANTI-VIRAL AND ANTI-INFLAMMATORY AGENTS
https://www.nst.com.my/news/nation/2021/07/711677/3-drugs-treating-covid-19
