Several treatments to treat Covid-19 patients are being studied around the world. Today, thanks to medical research, patients are better taken care of than at the start of the coronavirus epidemic. 

Clofoctol, a molecule discovered by the Institut Pasteur de Lille

Update January 14, 2021 – The private foundation is awaiting authorization from health authorities to launch human clinical trials. The drug is clofoctol, still prescribed until 2005 to treat mild respiratory infections and to be taken as a suppository.

The Pasteur Institute of Lille made a discovery “interestingOn one of the 2 molecules being the subject of their research. A team made up of scientists “Task Force»Has for sole mission to find a effective drug against Covid-19, since the start of the epidemic. She is experimenting with several treatments already approved and intervening to treat other pathologies. Prof. Benoît Déprez announces that the molecule is “particularly effective“And turned out to be”particularly powerful“Against the Sars-Cov-2, with”hope for rapid treatment“. The molecule concerned has been the subject of a series of tests since the beginning of the summer. Its advantage lies in the fact that it already has a marketing authorization, thus saving considerable time.

The drugs on which the Institut Pasteur is working are already approved, which saves them precious time. The molecule concerned is an anti-viral, which was already used to treat other diseases. His name was first kept secret then was revealed, it is the clofoctol. The experts came to a conclusion with a double effect on the disease : the remedy, taken early enough, when the first symptoms appear, would be able to reduce the viral load present in the body. If, on the contrary, the treatment is taken late, it would limit the development of severe form. This is a huge hope, as the pre-clinical trials on macaques could be published in May.

Anti-inflammatory drugs to be avoided in the event of Covid-19

Updated on March 16, 2020 – According to the latest observations and information disseminated by the French government, it would seem that taking anti-inflammatory drugs (Ibuprofen, cortisone, etc.) could be a factor in worsening the infection. Currently, clinical trials and several French and European programs are trying to refine the diagnosis and understanding of this disease in order to improve its management. Whatever the situation, it is generally recommended not to take anti-inflammatory drugs without medical advice first.

There is no specific treatment, but several treatments are being evaluated. In France, four vaccines are authorized, that of Pfizer / BioNtech, Moderna, AstraZeneca and Janssen Johnson & Johnson. Other research into anti-Covid vaccines is being carried out globally.

In the meantime, for mild forms of Covid-19, the treatment is symptomatic:

• Take paracetamol for fever and body aches,
• Rest,
• Drink a lot to rehydrate,
• Unclog the nose with physiological saline.

And of course,

• Confining yourself and respecting hygiene measures to avoid contaminating those around you,

A European clinical trial including 3.200 patients affected by a severe form begins in mid-March in order to compare four different treatments: oxygen therapy and respiratory ventilation versus remdesivir (antiviral treatment already used against the Ebola virus) versus Kaletra (a treatment against the Ebola virus). AIDS) versus Kaletra + a beta interferon (molecule produced by the immune system to better resist viral infections) to strengthen its action. Chloroquine (a treatment against malaria) which was mentioned at one time was not retained due to a significant risk of drug interactions and side effects. Other trials with other treatments are also being done elsewhere in the world.

How are patients infected with the new coronavirus treated?

As a reminder, Covid-19 is a disease caused by the Sars-Cov-2 virus. It has many symptoms, and usually shows up as a fever or a feeling of fever and signs of difficulty breathing such as coughing or shortness of breath. A person infected with Covid-19 can also be asymptomatic. The death rate would be 2%. Serious cases most often concern elderly people and / or people suffering from other illnesses.

Treatment is symptomatic. If you have one or more of the characteristic symptoms, in a moderate way, you should call your doctor before going to his office. The doctor will tell you what to do (stay at home or go to his office) and will guide you on the medications to take to relieve the fever and / or cough. Paracetamol is to be taken first to lower fever. On the other hand, taking anti-inflammatory drugs (ibuprofen, cortisone) is prohibited because they could worsen the infection.

If the symptoms worsen with breathing difficulties and signs of suffocation, call the SAMU Center 15 who will decide what to do. The most serious cases are hospitalized to benefit from respiratory assistance, increased surveillance or possibly be placed in intensive care.

Faced with the large number of serious cases and the spread of the virus around the world, several therapeutic avenues are currently being studied in order to quickly find a treatment and a vaccine.

Monoclonal antibody treatments

On March 15, 2021, the French Medicines Agency, the ANSM authorized the use of two dual therapy monoclonal therapy to treat Covid-19. They are intended for people at risk of progressing to serious forms, “because of an immunosuppression linked to a pathology or treatments, of advanced age or the presence of comorbidities”. The authorized treatments are therefore: 

• dual therapy casirivimab / imdevimab developed by the laboratory Roch;
• bamlanivimab / etesevimab dual therapy designed by the Lilly France laboratory.

The drugs are given to patients intravenously in hospital and preventively, that is, within 5 days at most after the onset of symptoms. 

Tocilizumab 

Tocilizumab is a monoclonal antibody and concerns patients with severe form of Covid-19. This molecule makes it possible to limit an amplified reaction of the immune system, one then speaks of “cytokine storm”. This overreaction of defense against Covid-19 causes breathing difficulties, requiring assistance.

Tocilizumab is normally used to treat rheumatoid arthritis. It is the B lymphocytes that produce this antibody. A study was carried out by the AP-HP (Assistance Publique Hôpitaux de Paris), in France therefore, on 129 patients. These Covid-19 patients suffered from a moderately severe to very severe lung infection. Half of the patients were given the drug tocilizumab, in addition to conventional treatment. The rest of the patients received usual treatment.  

The first observation is that the number of patients admitted to intensive care has decreased. Secondly, the number of deaths also fell. The results are therefore rather promising and the hope of a treatment against the new coronavirus is real. Studies are still ongoing, as the first results are promising. 

The preliminary results of some studies (American and French) have been published in JAMA internal Medicine, but they are controversial. The American study reveals that the risks of mortality in patients with severe Covid-19 are reduced when tocilizumab is administered within 48 hours after admission to the intensive care unit. The French study found no difference in mortality, but indicates that the risk of being on non-invasive or mechanical ventilation is lower in patients who received the drug.

Discovery clinical trial: drugs already on the market

The Institut Pasteur has announced the very imminent establishment of a clinical trial piloted by Inserm. It aims to “evaluate and compare four therapeutic combinations”:

Each will be associated with non-specific and symptomatic treatments for the Covid-19 disease.

• non-specific and symptomatic treatments alone.

This work will include 3200 hospitalized patients, including 800 in France. This clinical trial will be progressive. If one of the selected molecules is ineffective, it will be abandoned. Conversely, if one of them works on one of the patients, it can be tested on all the patients as part of the trial.

« The objective is to assess the efficacy and safety of four experimental therapeutic strategies that could have an effect against Covid-19 in the light of current scientific data. »As indicated by Inserm.

The Discovery trial will take shape with five treatment modalities, randomly tested on patients with severe coronavirus:

• standard care
• standard care plus remdesivir,
• standard care plus lopinavir and ritonavir,
• standard care plus lopinavir, ritonavir and beta interferon
• standard care plus hydroxy-chloroquine.

What is remdesivir? 

It was the American laboratory, Gilead Sciences, which initially tested remdesivir. Indeed, this drug has been tested to treat patients with Ebola virus. The results had not been conclusive. Remdesivir is an antiviral; it is a substance that fights against viruses. Remdesivir nevertheless offered rather promising results against certain coronaviruses. That’s why scientists decided to experiment this medicine against the Sars-Cov-2 virus.

What are his actions? 

This antiviral prevents the virus from replicating in the body. Le virus Sars-Cov-2 may cause too much immune reaction in some patients, which can attack the lungs. This is where remdesivir can come in, to control the “cytokine storm”. The drug will limit the inflammatory reaction and therefore lung damage. 

What results? 

Remdesivir has been shown that patients with a severe form of Covid-19 recovered faster than those who received the placebo. The antiviral therefore has an action against the virus, but is not a complete remedy to fight the disease. In the United States, the administration of this drug is authorized for emergency use.

In September, studies show that Remdesivir would have advanced the healing of some patients by a few days. Remdesivir is also believed to reduce mortality. This anti-viral is quite effective, but, on its own, does not constitute a treatment against Covid-19. However, the trail is serious. 

In October, studies revealed that remdesevir slightly reduced the recovery time of Covid-19 patients. However, it would not have shown any benefit in reducing mortality. The High Authority of Health considered that the interest of this drug was “low«.

The Hycovid test against the new coronavirus

A new clinical trial, named ” Hycovid Will be carried out on 1 patients, mobilizing 300 hospitals in France. Most of them are located in the West: Cholet, Lorient, Brest, Quimper and Poitiers; and the North: Tourcoing and Amiens; in the South-West: Toulouse and Agen; and in the Paris region. The Angers University Hospital is leading this experiment.

What protocol for the Hycovid trial?

The trial concerns patients with Covid-19, neither in a worrying state, nor in intensive care but at high risk of complications. In fact, most of the patients subjected to the test are either elderly (at least 75 years old) or have respiratory problems, with a need for oxygen.

The treatment can be administered to patients directly at the hospital, in nursing homes or simply at home. As Professor Vincent Dubée, principal instigator of the project at Angers University Hospital, indicates “We will treat people early, which is probably a determining factor in the success of the treatment”. In addition to specifying that the drug will not be attributed to all because some patients will receive a placebo, without the patient, or even the doctor knowing it.

The first results  

The main idea of ​​Professor Dubée is to “close the debate” on the effectiveness, or not, of chloroquine. A strict protocol that will give its first results within 15 days, with a conclusion expected by the end of April.

Chloroquine to treat the coronavirus?

Pr Didier Raoult, infectious disease specialist and professor of microbiology at the Institut Hospitalo-Universitaire Méditerranée infection in Marseille, indicated on February 25, 2020 that chloroquine could cure Covid-19. This antimalarial drug would have shown its effectiveness in the treatment of the disease, according to a Chinese scientific study published in the journal BioScience Trends. According to Professor Raoult, chloroquine would “contain the evolution of pneumonia, to improve the condition of the lungs, so that the patient becomes negative for the virus again and to shorten the duration of the disease”. The authors of this study also insist that this drug is inexpensive and its benefits / risks are well known because it has been on the market for a long time.

This therapeutic avenue must however be deepened because studies have been carried out on a few patients and chloroquine can cause potentially dangerous side effects. Hydroxycloroquine is no longer administered in France, as part of Covid-19, except if it concerns patients who were part of a clinical trial. 

The use of serums from cured people

The use of sera from convalescents, that is to say from people who have been infected and have developed antibodies, is also a therapeutic avenue under study. Research published in the Journal of Clinical Investigation shows that the use of convalescent sera could:

• prevent healthy people exposed to the virus from developing the disease;
• treat those who show the first symptoms quickly.

The authors of this study recall the need to protect the people most exposed to Covid-19, in particular healthcare workers. “Today, nurses, doctors and other health professionals are on the front line in the fight against Covid-19. They are exposed to proven cases. Some of them developed the disease, others were quarantined as a preventive measure, jeopardizing the healthcare systems of the most affected countries”, Conclude the researchers.

Nicotine would have a positive impact on the Covid-19 virus? This is what a team from the Pitié Salpêtrière hospital is trying to find out. The observation is that a very small number of people infected with Covid-19 are smokers. Since cigarettes mainly contain toxic compounds such as arsenic, ammonia or carbon monoxide, researchers are turning to nicotine. This psychoactive substance is said to prevent the virus from attaching itself to cell walls. Be careful, however, that in no way means that you have to smoke. Cigarettes are harmful to health and seriously damage the lungs.

This would involve applying nicotine patches to certain categories of people:

• nursing staff, for a preventive and protective role of nicotine;
• hospitalized patients, to see if symptoms improve;
• for severe cases of Covid-19, to reduce inflammation. 

The study is underway to demonstrate the effect of nicotine on the new coronavirus, which would have a preventive rather than a curative role.

Update of November 27 – The Nicovid Prev study, piloted by AP-HP, will extend across the country and include more than 1 nursing staff. The duration of the “treatment” will be between 500 and 4 months.

Update October 16, 2020 – The effects of nicotine on Covid-19 is still a hypothesis at this time. However, Santé Publique France encourages all initiatives to fight against the coronavirus. The results are eagerly awaited.

As the SARS-CoV-2 coronavirus is new, no complementary approach has been validated. It is nevertheless possible to try to strengthen its immunity by the plants recommended in case of seasonal flu:

• Ginseng: known to stimulate the immune system. To consume in the morning, ginseng helps fight physical fatigue to help regain strength. The dose varies from case to case, consult your doctor to adjust the dosage. 
• Echinacea: helps reduce the symptoms of a cold. It is important to take echinacea at the first sign of an upper respiratory infection (cold, sinusitis, laryngitis, etc.).
• Andrographis: moderately reduces the duration and intensity of symptoms of respiratory tract infections (colds, flu, pharyngitis).
• Eleutherococcus or black elderberry: stimulate the immune system and reduce fatigue, especially during flu syndrome.

On the other hand, taking vitamin D may decrease the risk of acute respiratory infections by boosting immunity (6). A study from the journal Minerva, Review of Evidence-Based Medicine explains that: Vitamin D supplements can prevent acute respiratory tract infections. The patients who benefit the most are those with severe vitamin D deficiency and those who receive a daily or weekly dose. ”It is therefore sufficient to take a few drops of vitamin D3 each day to reach 1500 to 2000 IU per day (IU = international units) for adults and 1000 IU per day for children. It is however very important to follow the recommendations of the prescribing doctor, to avoid having an overdose of vitamin D. In addition, vitamin supplementation does not exempt from respecting the barrier gestures. 

Physical exercise

Exercise stimulates the immune system. This is why it decreases both the risk of infections and cancer. So, to protect yourself from the coronavirus, like all infections, physical exercise is strongly recommended. Be careful, however, not to play sports in case of fever. In this case, it is necessary to rest because the risk of infarction seems to increase in the event of effort in period of fever. The ideal “dose” of physical exercise per day to boost immunity would be around 30 minutes per day (or up to an hour).