Self-medication for COVID-19 can lead to much more problems than the coronavirus itself. For example, injections of interferon at home can lead to a mental disorder, and the use of antibiotics can cause a surge in bacterial infections. Moreover, it is premature to comment on the results of the therapeutic use of Remdesivir, Favipiravir and Polyoxidonium.… How not to get confused in scientific publications, YouTube videos and tips for curing coronavirus, as well as the effectiveness of popular drugs used in the treatment of this infection, the head of the course of applied pharmacology and pharmacotherapy of the Faculty of Health Sciences of the University told in an interview with Izvestia OsloMet (Norway), head of international projects on patient safety and personalized medicine Yuri Kiselev.
– What are the most popular combinations and medications in the world that are now used in the treatment of COVID-19?
– Antiviral therapy, drugs to suppress excessive inflammation, as well as ancillary treatment, primarily drugs for the prevention of thrombosis.
Coronaviruses have been known for a long time, but there were no effective remedies against them before the current pandemic began. We tried several options, including drugs for malaria and HIV. But research has not confirmed either the therapeutic or prophylactic effectiveness of these drugs. These drugs, especially anti-malarial drugs, are not only useless, but also potentially dangerous.
Photo: TASS / Zuma
– Why is there still a problem of creating an effective antiviral drug?
– To destroy a pathogenic microorganism, you need to “beat” into a specific molecule or mechanism that is characteristic only of this pathogen, but is absent in humans, otherwise we will harm the patient. For example, in bacteria, penicillins act on a certain cell wall protein that our cells do not have. Viruses are parasites; they exist and multiply at the expense of the host. They have very few of their own unique “targets” that can be “hit” with drugs without fear of powerful side effects. Hence the difficulties with the development of any antiviral drugs.
— Recently, French scientists announced that the main characteristic feature of patients with severe COVID-19 course was identified – increased inflammation and interferon deficiency. Is it possible to carry out prevention by the introduction of these substances?
– Interferons are one of the elements of antiviral defense in the body. It is still unknown whether their deficiency could be a cause or a consequence of severe COVID-19. Some experts disagree with the findings of the French and provide opposite data.
One thing is for sure: you cannot use injectable forms of interferon on your own. These are drugs with frequent and severe side effects. For example, the number of leukocytes, those blood cells that protect us from infections, can dramatically decrease. Severe weakness, hair loss and skin rashes, gastrointestinal and even psychiatric disorders are possible. The latter include depressive conditions and sleep disturbances, less often mania and suicidal thoughts are manifested. In addition, the introduction of interferon-beta very often causes symptoms similar to ARVI, and it is difficult for a doctor to distinguish them from the true manifestations of the disease.
— Recently, the British company Synairgen issued a press release on the first results of a study of inhaled interferon in the treatment of hospitalized patients with COVID-19. This is dangerous too?
– The idea was to deliver interferon molecules directly to the lungs – a focus of the disease with the rapid multiplication of the virus. In terms of side effects, this is better: less drug will enter the bloodstream than with an injection. But the study included only 101 patients, which is very few. The risk of being ventilated or dying was 79% lower with interferon versus placebo. If this data is confirmed, it will revolutionize treatment.
— During COVID-19, excessive, hyperactive inflammation is noted. What tools work here?
– Of the most proven approaches to date, I would like to note the use of the well-known steroid hormone “Dexamethasone”, used, for example, in life-threatening allergic reactions. In the UK, this drug has shown a reduction in mortality in severely hospitalized patients. But not all patients with COVID-19 are the same: in the same study, Dexamethasone did not benefit patients who breathed on their own and without an oxygen mask. The US National Institutes of Health has spoken out against its use in patients with mild COVID-19. This is due to a wide range of side effects of this drug: increased pressure, impaired adrenal function, increased blood sugar, risk of infections. That is, the total prescription of such drugs is not recommended for all patients and is dangerous.
Photo: REUTERS / Benoit Tessier
– How do you feel about the practice of using antibiotics against coronavirus infection?
— Preschoolers already seem to know that antibiotics do not work on viruses. However, in real Russian practice of treating COVID-19 they are used very widely. There are two reasons: for “Azithromycin” there are laboratory data on its immunomodulatory effect, and other antibiotics are prescribed in case the patient has combined viral-bacterial pneumonia.
Antibiotics must be used deliberately, selectively, because their general use in coronavirus infection only contributes to the further spread of a more dangerous problem – the resistance of bacteria to them. The overuse of antibiotics in COVID hospitals will aggravate the already very unfortunate situation with nosocomial resistant infections, and it is extremely difficult to get rid of the flora once rooted in the department.
— Different governments are betting on different drugs. Thus, in the USA, Remdesivir came to the fore. What is the latest evidence on its effectiveness?
– American recommendations support the appointment of Remdesivir to hospitalized patients with coronavirus with a decrease in saturation (saturation of hemoglobin with oxygen. – Izvestia) below 95% and in patients who need oxygen therapy. Its effect in patients on mechanical ventilation is not yet clear. The European Medicines Agency draws attention to the possible risk of renal toxicity. This drug should also not be used together with hydroxychloroquine, which is still popular in Russia.
– In Russia, Favipiravir is the headliner among the coronavirus remedies. How promising is it?
— Recently, there were reports from Japan about the unimpressive first results of the Favipiravir randomized trial in COVID-19… In Russia, they are more optimistic and point to the advantages of domestic research. In neither case, there is still no access to a full description of the results, and therefore it is impossible to comment on something. At least in outpatients with a mild course of the disease, its use seems to me risky, since the effectiveness of the drug has not yet been proven, and there are questions about safety.
I want to remind you: women of childbearing age should be tested for possible pregnancy before prescribing the drug, or receive effective contraception, as it can lead to fetal pathology.
– What can you say about “Arbidol”?
— It worries me that this drug is registered in a very small number of countries. But, as far as I know, it is used only in Russia and China. A logical question arises: why hasn’t it taken over the world yet, since it is so effective?
Some laboratory data have been published on it. It was seen as one of the molecules that could potentially be useful in the coronavirus. But that was at the preclinical level. In China, it was examined in a clinic on patients. But these studies themselves are of low quality. For example, in one of them “Arbidol” was compared with an HIV drug, which itself was ineffective. There is a lot of rubbish in publications now, and you need to approach them critically. In general, the effectiveness of this drug for COVID-19 has not yet been proven.
Photo: REUTERS / Amr Abdallah Dalsh
– Recently, the Russian immunomodulator Polyoxidonium also passed the first part of the tests in the context of the coronavirus. What can you say about him?
– From the point of view of pharmacology, I have nothing to comment on. The scientific literature does not describe a specific molecular mechanism of its action, and there are no studies on patients with COVID-19. Anyway, immunity is not a car, here you cannot take and add gas. This is a very complex system of checks and balances that cannot be strengthened with one pill.
— There are also alternative approaches to the treatment of coronavirus – using vitamins, natural compounds, and so on. What do you think of them?
– With regard to COVID-19, a lot has been said about three things in recent months — vitamin C, zinc and vitamin D. For ascorbic acid, which we are used to using for colds and flu, the news is not very positive. Even with ordinary acute respiratory viral infections, additional intake of vitamin C did not show effectiveness. It may be justified in severe cases when oxidative stress develops and the antioxidant properties of ascorbic acid may be beneficial.
British studies have shown no link between vitamin D levels and coronavirus risk. By the way, daily intake of high doses of vitamin D (4000 IU and more) can lead to decreased bone density and other side effects, which has been shown in studies.
As tempting as the lab results look, for zinc evidence of curative or prophylactic efficacy against COVID-19 also no.
– What advice would you give ordinary people to prevent COVID-19?
– Today we observe what, in the words of one of my colleagues, can be called a “pharmacological bacchanalia”. I would like to reiterate the well-known rule: do not take prescription drugs without a doctor’s prescription. Do not inject yourself with the blood-thinning drugs left by your grandmother after the operation, do not ask your neighbor-nurse to drip at home «Dexamethasone», do not ask the pharmacist to sell four different antibiotics and do not take them in handfuls – these are all examples from life. And, most importantly, remember that more than 98% of coronavirus patients recover, most without any treatment other than banal antipyretic drugs. We have a reliable ally – our immunity, and we shouldn’t underestimate it. But we also have an enemy – this is panic, which is sometimes difficult not to succumb to, but it is dangerous for both the patient and the doctor.