Q) With the cases of COVID seeming to skyrocket throughout Ontario, is there anything that can be done to treat it besides putting me on a ventilator if I were to catch the virus?
A) This is probably a good question to tackle again since we haven’t really addressed the treatment of COVID-19 since Trump declared hydroxychloroquine to be the answer we were all seeking (in a shocking development, it turns out his clinician skills may be even worse than his presidential ones). The unfortunate reality of the current surge in case numbers is that this is going to be a consideration for at least some of us in the next few months.
There are different and effective options available that are used primarily in a hospital setting such as tocilizumab. This is a monoclonal antibody drug that has traditionally been used to treat rheumatoid arthritis and complications from cancer treatments. It is administered by a simple injection into the thigh or abdomen, much like insulin. Unfortunately supplies of this drug and others like it are in very short supply both in Canada and throughout the world which has forced physicians to make truly difficult decisions as to who actually gets treated.
Since those options appear to be scarce, let’s look at outpatient treatments (i.e. the medical treatment of people conducted outside of a hospital) and focus on the pharmaceutical care that you may be prescribed as you recover at home. All of the drugs that will be discussed here have been around for decades and therefore have been designed and used to treat other completely unrelated conditions.
Another trait they share in common is that the data to support their use versus COVID-19 is still in its infancy so it could well be that with further investigations none of these may stand the test of time, much like hydroxychloroquine. That being said, the options are generally considered safe and all have at least some science behind their use.
The first drug, and probably the one mentioned most often is colchicine, a drug we have been using forever to treat gout. In a trial of 4,000 people with non-severe COVID-19, treatment with this pill (0.5 mg twice daily for 3 days, followed by 0.5 mg daily for a total of 30 days), reduced the risk of hospitalization in adults age ≥40 years who were at risk of becoming severely ill (i.e. they had other risk factors such as diabetes, COPD….) by 25%.
This is significant but comes with the following caveats: First, colchicine produced no reduction in the mortality rate or the need for ventilation. Secondly, the drug has plenty of interactions with other drugs, is prone to causing diarrhea and an upset stomach and has been associated (though rarely) with a risk of a pulmonary embolism (i.e. a blood clot in your respiratory system). Lastly, the study was not peer reviewed (i.e. not open to scrutiny and possible criticism from other researchers which is an important part of any scientific query. Note this process is usually entirely absent from the many websites which still blithely publish rubbish that has caused some people to believe that vaccines are intended to somehow control us or in other ways harm us. Sorry for the digression.
The inhaler Pulmicort (budesonide) is currently being used for some symptoms of COVID-19. This has been a safe and effective mainstay in asthma treatment for decades and belongs to the inhaled corticosteroid family. The case for budesonide is based upon a study of 139 patients in the United Kingdom who were diagnosed with early and mild forms of COVID-19. At a dose of 800 mcg twice a day, for on average a week, those treated with the inhaler were far less likely (1.4% vs 14.4%) to later require hospitalization or some other form of urgent care. While those are certainly encouraging results and budesonide is considered safe enough to use even in infants when it comes to asthma control, excitement must be tempered by the fact that this is only a single study and a very small one at that.
Another drug that has received some hype as a possible treatment for COVID-19 is the antiparasitic drug invermictin. If you thought that the research appears scant for the two drugs we have already discussed, the case for invermictin is even sparser. There is some weak observational data suggesting that invermictin may be effective for patients with severe COVID-19 symptoms. However, this is tempered by a small randomized controlled trial of the drug in patients with mild to moderate forms of the disease that demonstrated that the drug failed to improve clinical outcomes or reduce deaths. When combined with the fact that invermictin has been associated with nausea, vomiting, diarrhea, stomach pain, swelling, dizziness, seizures, confusion, sudden drops in blood pressure and hepatitis, the case for treating yourself as a guinea pig and trying the drug would appear to be suspect.
The last drug to discuss is fluvoxamine, which is, of all things, an antidepressant from the Prozac (selective serotonin reuptake inhibitors or SSRI’s as they are more commonly known as) family of drugs. There are two very small studies (i.e. 100 to 200 patients each) with mild courses of the disease who appeared to have less shortness of breath and a reduced incidence of hospitalization when taking fluvoxamine as opposed to a placebo. Once again, both studies were limited not only by their sizes but also by their short duration which lead to an inability to follow-up and see how the patients eventually faired.
As you can see, to the best of our knowledge so far, none of these drugs is a magic bullet. However, with further study perhaps a solid case can be built for one of these drugs or possibly one of the many other agents currently being investigated (such as the diabetic pill linagliptin, the blood pressure drug losartan, the statins commonly used for lowering cholesterol or perhaps even vitamin D among others) as being a “go-to” when it comes to treating COVID at home. Only time will tell. For more information about these or any other health related questions, contact your pharmacist.
