CV-19 therapeutic drug trials

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Jersey Girl
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CV-19 therapeutic drug trials

Post by Jersey Girl »

I was watching youtube videos and came across one by a lung doctor who explained the pathogenesis of CV-19, how the virus enters the body, what it does to your lungs and how people essentially crash due to ARDS-- it kills some people but not others. Right? In the video he mentions a couple of medications saying that people who take them will likely have an easier go of it if infected because they ward off ARDS and my antennae went up*. He refers to another video he's done about the current drug trials involving 10 (I believe) medications.

I watched the second video. He explains how the clinical trials work and he goes through each medication and explains how each one works, then offers his opinion regarding the potential for each to emerge as a first line treatment for COVID-19 and ranks them. (I quickly looked up some of the clinical trials and they check out.)

He even goes over the monoclonal antibodies and how they make one vulnerable to other infection (which I already knew about long before CV-19 came along) and the use of convalescent plasma.

The clinical trials are something I hadn't looked into yet except for reading about Remdesivir and Hydroxychloroquine. I think these videos are a good intro to the topic.

If you are interested:

Video 1: https://www.youtube.com/watch?v=LV8wWhjTKRU

Video 2: https://www.youtube.com/watch?v=xBWaWqXZgko

* My antenna went up because Jersey Boy and I both take one of the listed meds that are currently under trial. :surprised: The fact that these are being trialed as therapeutic treatments for CV-19 has got me thinking that they might be protective for us.

EAllusion
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Re: CV-19 therapeutic drug trials

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This isn't a direct response, but I did some weekend catching up on scientific publications on the disease and came away with the impression that we still know very little about how it works, what symptoms it causes in what populations, and why. I was surprised because I thought the global focus and large population size to study would speed things up more than they have, but that may have been an unrealistic expectation.

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Jersey Girl
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Re: CV-19 therapeutic drug trials

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That's direct enough, EAllusion. I came upon that first video just on chance. I'm going to turn my attention to the clinical trials now and investigate further. What I liked about the two videos is that he explained his rationale and both are instructive to regular folks without a medical background.

Do you think that it's difficult to gather global information for study is because the information is incomplete? I haven't looked at any of that. I'm wondering if the symptoms issue is because some symptoms are under reported?

I also read an article last night (actually wee hours of the morning) where New York City is dosing up patients with high doses of heartburn meds--Pepcid I believe it was because they suspected it was helping. So whatever hospital that was, they're doing their own in-house clinical trial on that.

Yeah, so I'm going to learn more about the clinical trials that are accessible online. I've been reading clinical trials/studies for 6 years now I figure I can wade my way through them with some amount of understanding. I checked 3 or so from the video and they're right there for the reading.

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Res Ipsa
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Re: CV-19 therapeutic drug trials

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I think it’s partly because early information gathered in a crisis setting is likely to get significant things wrong. That, plus the fact that this coronavirus is behaving in ways we haven’t seen before. It’s creating all kinds of conditions that kill us, but we don’t know yet how it’s doing it.

I haven’t had time to dig into drug trials. Please let us know what you find.

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Re: CV-19 therapeutic drug trials

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RI if you have interest and time, watch the first video I linked where the doc is explaining how the virus manifests itself in humans...how it enters and it's mechanisms. It demonstrates why they're trialing the drugs that they are.

I dunno. If I had to choose an option this very second, I'd go for the convalescent plasma which I am sure is in short supply.

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Re: CV-19 therapeutic drug trials

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ETA: I forgot to mention this. The doc in the video suspects that the reason that the fatality rates are higher in males than females has to do with estrogen.

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Jersey Girl
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Re: CV-19 therapeutic drug trials

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Remdesivir

Fauci touts clinical trial of COVID drug as 'quite good news'

https://thehill.com/policy/healthcare/4 ... -good-news

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Jersey Girl
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Re: CV-19 therapeutic drug trials

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Jersey Girl wrote:
Wed Apr 29, 2020 12:54 pm
Remdesivir

Fauci touts clinical trial of COVID drug as 'quite good news'

https://thehill.com/policy/healthcare/4 ... -good-news
And...the FDA is planning to issue an emergency authorization for Remdesivir.

https://www.nytimes.com/2020/04/29/us/c ... eaths.html

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Jersey Girl
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Re: CV-19 therapeutic drug trials

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If you guys listen to the Fauci remarks, notice where he discusses that Remdesivir blocks an enzyme. That's exactly why they're also trialing the ACE inhibitors because they suspect the enzyme is how the virus enters the body and ends up causing the cytokine storm that cause patients to develop ARDS. Patients start tanking, end up on vents and either recover or die from it, so they're trying to find therapeutic options that block the enzyme from the start.

If you saw a dust up in the news about a study in Wuhan that doesn't lean in favor of Remdesivir, Dr. Fauci addresses that as well in the link that I posted.

Anyway, some promising research going on. I think that if I were to become infected with this virus and if I had a say in it, I'd go for convalescent plasma.

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Re: CV-19 therapeutic drug trials

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Yes this is great news indeed. If not a cure it seems to be, at the very least, a drug that can minimize the severity of the infection.

Kinda like Tamiflu for Influenza. The news about this drug has escaped the headlines for months, but probably because it was living in Hydroxychloroquine's shadow the whole time.

February 25:
Gilead Sciences drug remdesivir may help treat coronavirus symptoms
https://www.cnn.com/2020/02/24/investin ... index.html

March 9:
"Researchers are studying whether the antiviral drug remdesivir might work, but testing of that drug just started."
https://www.cnn.com/2020/03/09/health/c ... index.html

March 30:
"Officials at the World Health Organization have touted remdesivir as having the most potential to effectively treat coronavirus patients. The WHO has begun clinical tests of the drug on patients in Spain and Norway."
https://www.cnn.com/2020/03/30/investin ... index.html

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Jersey Girl
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Re: CV-19 therapeutic drug trials

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Yes, what we're seeing is innovative research in real time. Of course, many or most folks don't think this is coming fast enough but the truth is that it's coming down in warp drive. The Remdesivir was mentioned on the board probably a month ago but thanks to Trump who single focused on Hydrochloriquine (I just typed that without looking up the spelling, hope I got close) it faded into the background.

Since the development of one or more vaccines is going to take longer than therapeutics, I think we all have reason to be hopeful about this research until vaccines are ready for roll out.

I still see convalescent plasma as a more immediate fix but I have no way of knowing how scarce that might be right now.

For myself and Jersey Boy, we're both on one of the meds that are under trial. I'm hoping that matters in terms of providing some level of protection against the cytokine storm that kills.

ETA: Just looked at Icarus' post. Hydroxychloroquine. ;-)

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Re: CV-19 therapeutic drug trials

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This isn't about drug trials. People read up on diffusion hypoxia and CV-19, and what they're saying about the vents. I don't think I can articulate the problem better than this right now but it's akin to the effects of high altitude. They are seeing that when they put people (don't know what percentage) on the vents, their saturation levels are dropping into the 20's and 30's. That's the direct opposite of what they would expect to see happen. This is based on what ER and ICU doctors are observing in their vent patients. These doctors are suggesting that if patients are put on vents, that the pressure should be set low with the oxygen raised up or that they should be treated using hyperbaric units, and possibly that there's a place for CPAP machines in the treatment.

I've never checked my pulse-ox when returning to altitude but I know something about what they're describing. Instead of people coming in gasping for air, patients are able to speak easily but their saturation levels are low. They drop to even more dangerous levels when placed on the vents. It has something to do with the pressure of the vents destroying the alveoli surfactant tension ( causing the lungs to become stiff when supplemental oxygen is the key without the added pressure) in these patients until they can no longer breathe with or without the vent.

I'm afraid we're going to find out that the vent patients have essentially been killed on account of the standard protocols. I know we're seeing so much contradictory information regarding treatments but this is coming directly from doctors treating patients who were perplexed by what they were seeing, so look for articles and reports online about this.

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Re: CV-19 therapeutic drug trials

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I read the r/Covid19 sub every day. There's usually discussion of the latest studies on drugs and treatments. Unfortunately most of these studies have been observational and not quality, randomized controlled trials. A lot of them have also only been about giving the drug to severely ill patients, but that a drug does not work in the severely ill doesn't mean it won't halt the virus if given after symptom outset.

It's very unfortunate to me that HCQ became the political football it did. It was known to have some efficacy against SARS since 2005, which is part of the reason it was being studied for COVID19. It was being discussed on r/Covid19 long before Trump picked up on it. Now a lot of people seem to want it to fail just because they hate Trump. I'm still waiting for a good trial on patients receiving it early after symptom onset.

Other drugs that have been discussed on r/covid19 include ivermectin, avigan (favipirivir), and famotidine (Pepcid). Remdesivir has to be given in an IV and is hard to make, so it would be great if an existing drug that's more easily administered proved effective against COVID19. Though at this point I'd settle for a rock to throw at this thing.

There was another new drug, a pill, being studied, but the name escapes me. There's also been a lot of discussion on whether having adequate vitamin D levels inhibits or reduces infection severity. (I fixed my vitamin D levels years ago and would recommend it to anyone for non-covid19 reasons. It really improved my mood.)

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Re: CV-19 therapeutic drug trials

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MsJack wrote:
Tue May 05, 2020 4:16 am
I read the r/Covid19 sub every day. There's usually discussion of the latest studies on drugs and treatments. Unfortunately most of these studies have been observational and not quality, randomized controlled trials. A lot of them have also only been about giving the drug to severely ill patients, but that a drug does not work in the severely ill doesn't mean it won't halt the virus if given after symptom outset
May I make a suggestion?

Unless you have unlimited time, intellectual energy and emotional resources, stop "read[ing] the r/Covid19 sub every day". Instead, make use of the professional filtering and quality control that you can get from a source like this:

New England Journal of Medicine free COVID-19 resources

That way you will no longer have to wade through material (much of it worthless) of the kind you get on message boards - using that as a source of information on an urgent topic is a little like feeding your family on a random selection of what you might find in a dumpster behind a supermarket. To say the least, that is likely to result in severe indigestion ...

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Re: CV-19 therapeutic drug trials

Post by EAllusion »

I read Science and Nature routinely, which obviously now have a lot of COVID material. A few of the people I've followed since the science-blog days have expertise in this area and I follow their conversation and reading suggestions. I don't have any expertise in epidemiology, immunology, or anything like that, but I do have a background in cell biology which helps me process information as it comes out more easily than the average person I suppose.

Some days, it feels like we're still in the "mysterious gay cancer" phase of this epidemic. You just sit back and marvel at how far we've got to go yet. There's so much we don't know.

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Jersey Girl
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Re: CV-19 therapeutic drug trials

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Here's one of many on the diffusion hypoxia and vents.

https://www.livescience.com/silent-hypo ... ients.html

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Jersey Girl
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Re: CV-19 therapeutic drug trials

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MsJack wrote:
Tue May 05, 2020 4:16 am
I read the r/Covid19 sub every day. There's usually discussion of the latest studies on drugs and treatments. Unfortunately most of these studies have been observational and not quality, randomized controlled trials. A lot of them have also only been about giving the drug to severely ill patients, but that a drug does not work in the severely ill doesn't mean it won't halt the virus if given after symptom outset.

It's very unfortunate to me that HCQ became the political football it did. It was known to have some efficacy against SARS since 2005, which is part of the reason it was being studied for COVID19. It was being discussed on r/Covid19 long before Trump picked up on it. Now a lot of people seem to want it to fail just because they hate Trump. I'm still waiting for a good trial on patients receiving it early after symptom onset.

Other drugs that have been discussed on r/covid19 include ivermectin, avigan (favipirivir), and famotidine (Pepcid). Remdesivir has to be given in an IV and is hard to make, so it would be great if an existing drug that's more easily administered proved effective against COVID19. Though at this point I'd settle for a rock to throw at this thing.

There was another new drug, a pill, being studied, but the name escapes me. There's also been a lot of discussion on whether having adequate vitamin D levels inhibits or reduces infection severity. (I fixed my vitamin D levels years ago and would recommend it to anyone for non-covid19 reasons. It really improved my mood.)
Is that reddit you're talking about? I don't read there unless it's been linked from MormonDiscussions.com. There are currently (or was last I checked) 10 meds that are being trialed to mitigate the effects of CV-19. Some you've mentioned there. Also included are ACE1 inhibitors and ARB's. Couple of others I believe that you haven't got listed there. I should have posted the list but I was excited about my being on one of the meds at the time and failed to post it.

If what's being said about Vitamin D is true, I'm essentially bullet proof.

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Chap
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Re: CV-19 therapeutic drug trials

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Jersey Girl wrote:
Tue May 05, 2020 2:50 pm
Also included are ACE1 inhibitors and ARB's.
See this, perhaps:

Renin–Angiotensin–Aldosterone System Blockers and the Risk of Covid-19
CONCLUSIONS
In this large, population-based study, the use of ACE inhibitors and ARBs was more frequent among patients with Covid-19 than among controls because of their higher prevalence of cardiovascular disease. However, there was no evidence that ACE inhibitors or ARBs affected the risk of COVID-19.

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Jersey Girl
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Re: CV-19 therapeutic drug trials

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Chap wrote:
Tue May 05, 2020 3:11 pm
Jersey Girl wrote:
Tue May 05, 2020 2:50 pm
Also included are ACE1 inhibitors and ARB's.
See this, perhaps:

Renin–Angiotensin–Aldosterone System Blockers and the Risk of Covid-19
CONCLUSIONS
In this large, population-based study, the use of ACE inhibitors and ARBs was more frequent among patients with Covid-19 than among controls because of their higher prevalence of cardiovascular disease. However, there was no evidence that ACE inhibitors or ARBs affected the risk of COVID-19.
Trust me, I've read numerous articles and studies in progress. It's not about affecting the risk, it's about fending off the cytokine storm--tamping that process down.

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Jersey Girl
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Re: CV-19 therapeutic drug trials

Post by Jersey Girl »

EAllusion wrote:
Tue May 05, 2020 2:32 pm
I read Science and Nature routinely, which obviously now have a lot of COVID material. A few of the people I've followed since the science-blog days have expertise in this area and I follow their conversation and reading suggestions. I don't have any expertise in epidemiology, immunology, or anything like that, but I do have a background in cell biology which helps me process information as it comes out more easily than the average person I suppose.
Okay, brain. ;-) Read up on the diffusion hypoxia and get back to us, please.
Some days, it feels like we're still in the "mysterious gay cancer" phase of this epidemic. You just sit back and marvel at how far we've got to go yet. There's so much we don't know.
As I see it, that's exactly where we're at right now. We're throwing stuff against the wall like pasta to see if anything sticks.

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Re: CV-19 therapeutic drug trials

Post by EAllusion »

Huh. Speaking of "mysterious gay cancer" phase, it's looking like concern about possible inflammatory syndromes in children can be upgraded from "way too preliminary to be on the average person's radar to worry about" to "hold on to your butts."

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