Which COVID-19 Antivirals Actually Work?

In emergency rooms around the world, doctors and nurses are writing the playbook for treatment of COVID-19. With so much about the virus, the disease, and effect of various treatments still evolving, doctors are improvising on the spot trying to figure out the approach that will give their patients the best shot at survival.

Antiviral medications are among the options that doctors are considering as a way to treat the disease. The drugs work on SARS-CoV-2 itself, targeting the functions of the virus and preventing it from replicating in the body. As I wrote about in a column earlier today, a group of physicians in Hong Kong recently reported success with a cocktail of antiviral drugs to treat COVID-19.

The four drugs used include lopinavir and ritonavir (two anti-HIV drugs), ribavarin (a broad spectrum inhibitor of RNA viruses), and interferon-1beta (a drug that stimulates antiviral immune responses). Their study shows that treatment with the cocktail can reduce recovery time from 12 days to 7 in patients with mild to moderate symptoms.

This is much needed counsel for doctors struggling to keep their patients alive. Compare the information shared by these doctors with the data being shared on another antiviral drug currently being touted as the new standard of care: remdesivir. The data on remdesivir has been far less transparent. A controlled clinical study out of China suggests the drug brings no benefit to patients. Yet the National Institute of Allergy and Infectious Diseases said their study showed their was a benefit to patients, with recovery time reduced from 15 days to 11 days. The catch is that they have yet to release the full data from the study, nearly two weeks after they made the announcement of the preliminary results.

The suspect nature of this lack of transparency aside, imagine what it means for doctors in emergency rooms today. Here you have two different antiviral treatment options available:

One — remdesivir — has no track record of success, as it’s a new drug. Doctors have been given no access to the data proving it’s beneficial effects. There has also been no data shared about the drug’s ability to reduce a patient’s viral load, a key marker of success for an antiviral drug.

The other — the four-drug cocktail tested in Hong Kong — has a proven track record from the use of these drugs on other viral diseases like HIV/AIDS. The data showing the cocktail’s benefits for COVID-19 have been shared widely and published in a respected, peer-reviewed journal. The data also shows the impact the drugs have on reducing a patient’s viral load, though perhaps not by as much as doctors might have hoped.

The task facing our healthcare providers is difficult enough already without us clouding their view of the treatments that work. Remdesivir is still an unknown, despite the hype surrounding it. I have seen through the years the dangers of relying on unproven cures and the damage done to patients when we allow ourselves to be deceived by hope and ignore the data.


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Originally published on Forbes (May 11, 2020)

© William A. Haseltine, PhD. All Rights Reserved.