What is COVID-19 treated in Poland? Here are the recommended medications

Although the Omikron infection in most cases causes a mild course, which can be dealt with at home, there are still many patients among us who require more advanced pharmacotherapy. What opportunities do they face? Which COVID-19 drugs are currently used in Poland and in what cases are they administered?

1. Recommendations on how to proceed in the case of coronavirus infection depending on the course of COVID-19 have been developed by the Polish Society of Epidemiologists and Doctors of Infectious Diseases
2. The effectiveness of the prescribed drugs depends largely on the time at which they are given
3. In the home course of COVID-10, it is recommended, inter alia, molnupiravir, which can already be prescribed to patients by GPs
4. Pharmacotherapy is least effective in the fourth stage of COVID-19, in which ARDS – acute respiratory distress syndrome occurs.
5. Respond before it’s too late. Get to know your Health Index!
6. More information can be found on the Onet homepage

COVID-10 treatment in Poland: official recommendations

Recommendations for the management of SARS-CoV-2 infections have been developed by the Polish Society of Epidemiologists and Doctors of Infectious Diseases (PTEILCHZ). Experts divided the recommendations according to the type of COVID-19 course, taking into account both basic and supportive treatment. In each of them, specific medications are indicated that are recommended by doctors and epidemiologists to treat the infection, taking into account the time of initiation of therapy, which is key to its effectiveness.

The oligosymptomatic stage

If the course of COVID-19 is mild and the patient does not require hospitalization, it is very important that treatment is started within the first five days of onset of symptoms. In basic treatment, the following are recommended:

1. molnupirawir – an oral antiviral drug that is already periodically authorized in Poland. Lagevrio (molnupiravir) has not been approved by the European Medicines Agency (EMA), but the agency has issued a positive opinion about it, and the drug is on the market, inter alia, in the UK. According to studies, the use of molnupiravir may reduce the need for hospitalization for COVID-19 in people at higher risk by up to 50%. Dosage: twice daily (800 mg) for five days.
2. kasiriwimab/imdewimab – they are monoclonal antibodies, i.e. modified proteins that mimic natural antibodies and recognize specific antigens. Their task is to fight the virus, reduce its amount in the body and “buy” time for it to make its own antibodies. The EMA reports that kasirivimab and imdevimab are designed to attach to the SARS-CoV-2 virus peak protein at two different sites so that the virus cannot enter the body’s cells. During SARS-CoV-2 infection, the drug containing them is administered intravenously or subcutaneously in a single dose of 1200 mg. 

These drugs are recommended especially to patients at risk of a severe course of infection and should be administered within the first five days of the onset of symptoms.

Supportively, it is recommended, among others inhaling Budesonide, which contains an anti-inflammatory corticosteroid, and in addition: low molecular weight heparin (in the case of constantly lying patients), drugs that respond to specific ailments: fever, cough, runny nose, sore throat, hydration and rest.

1. Also read: How Much Does COVID-19 Treatment Cost At Home?

Systemic corticosteroids, antibiotics and anti-influenza medications are contraindicated, unless there is a bacterial superinfection or influenza coexistence.

The rest of the text below the video.

Full symptom stage

When COVID-19 becomes severe, saturation drops below 94%, and the patient requires hospitalization, one of three drugs should be introduced as part of pharmacological treatment:

1. remdesiwir – it is an inhibitor of viral RNA polymerase that interferes with the production of SARS-CoV-2 genetic material and thus prevents the virus from multiplying in cells. According to research, when used intravenously once a day for five days, it can significantly reduce the hospital stay and treatment of COVID-19 patients;
2. molnupirawir – orally twice a day (800 mg) for five days,
3. kasiriwimab/imdewimab – a single dose of 1200 mg intravenously or subcutaneously.

In this case, supportive treatment is similar to that in the oligosymptomatic stage, with low molecular weight heparin (a substance preventing blood clotting) being administered in prophylactic or therapeutic doses. PTEILCHZ recommends considering the use of dexamethasone (a glycocodicosteroid with an anti-inflammatory effect), but only in patients receiving antiviral medications and receiving oxygen therapy.

1. See also: Molnupiravir – Here’s What You Need to Know About the First Oral COVID-19 Drug [EXPLAINED]

Stage with respiratory failure

In patients whose saturation drops below 90% and the so-called cytokine storm (excessive and violent reaction of the immune system to the pathogen, resulting in the formation of pro-inflammatory cytokines), it is recommended, if possible and the patient’s condition, to introduce one of the following drugs or substances for treatment:

1. tocilizumab – humanized monoclonal antibody produced with the use of recombinant DNA technology, used, inter alia, in in the treatment of rheumatoid arthritis (RA). In COVID-19 respiratory failure, they are administered to people with IL-6 levels> 100 pg / ml in a single intravenous infusion;
2. baricytynib – a selective and reversible inhibitor of Janus kinase (JAK1 and JAK2), that is, enzymes that “tell” cytokines and other growth factors important for generating an immune response that inflammation is starting in the body. This substance is used in the treatment of active arthritis and atopic dermatitis. In the case of COVID-19, it is administered orally at a dose of 4 mg per day until the end of hospitalization (but not longer than 14 days);
3. phosphoran dexamethasone – a synthetic form of a glucocorticosteroid with a strong anti-inflammatory, antiallergic and immunosuppressive effect. It is given, among others in the treatment of rheumatic and autoimmune diseases, asthma and brain edema. In the treatment of COVID-19, it is used intravenously at a dose of 6-8 mg for seven to 10 days.

Supportive measures include low- or high-flow oxygen therapy, intravenous hydration, low molecular weight heparin, symptomatic treatment, and if there is a secondary bacterial infection, also antibiotic therapy.

1. Read also: The new drug combination is highly effective in treating COVID-19

Stage with acute respiratory distress syndrome (ARDS)

The Polish Society of Epidemiologists and Doctors of Infectious Diseases does not hide that in the case of patients with ARDS, there are currently no fully effective methods of pharmacotherapy. Patients with COVID-19 who develop acute respiratory failure undergo mechanical lung ventilation and stay in the anesthesiology and intensive care unit. They are treated with:

1. phosphoran dexamethasone – administered in a daily dose of 6-8 mg for seven to 10 days, and if this is unavailable, other glucocorticoids in equivalent doses are indicated, e.g. hydrocortisone, methylprednisolone or prednisone and / or
2. tocilizumab – in combination with dexamethasone, it can also be administered to ventilated patients (from the first day on a ventilator).

To increase the effectiveness of the treatment of the critical course of COVID-19, apart from invasive or non-invasive ventilation, high-flow oxygen therapy, extracorporeal veno-venous transmembrane oxygenation (the so-called VV ECMO) and low molecular weight heparin are supplemented.

1. See also: The Polish patient spent 140 days under ECMO. It is risky, very expensive, it does not heal, but it saves lives. What is this?

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