A phase II clinical trial has found that a combination of three drugs — interferon beta-1b, lopinavir-ritonavir, and ribavirin — plus standard care is successful in treating mild-to-moderate cases of COVID-19. This three-drug combination also shortens the duration of viral shedding — that is, the period during which the virus is detectable in a person’s body and transmissible to others.The results of the new multicenter, prospective, open-label, randomized trial now appear in the journal The Lancet.
Reference : https://www.thelancet.com/pdfs/journals/lancet/PIIS0140-6736(20)31042-4.pdf
Hi, Dear Dr.Durrani
I am working at ICU, where intubated and extubated patients are followed. I believe that, after applying primary treatment (Oseltamivir / Hydroxychloroquine / Favipravir) for COVID-19, tocilizumab or anakinra treatments will be more effective on prognosis.
In my experience, the success rate of Lopinavir/ritonavir treatment is obviously lower compared to other second-line treatments and its combination effects are still suspicious. In this study, they didn’t use triple combination for patients who started treatment 7 days or more after symptom onset and as they explained at the end of their study, their trial was open-label and there were no placebo group.
As a result, many of the combined therapies are still in the trial phase, and their effects on pulmonary healing are not yet clear and the side effects are not yet clear.
I want to share another study about interferon beta-1 b
Probably the major issue would be any off-target side effect of the drugs that should be well-measured.
I believe it is not practical to give 3 or 10 drugs and say there is decreasing in duration of viral shedding. It is not worth even to try this approach.
I believe till now, you need good patient care + convalescent plasma (for moderate and severe cases) + Tocilizumab "IL-6 receptor inhibitor"(for severe cases that you think of cytokine storm) if it is available and there is no contraindications.
Regards,
Abdul Hadi Al-Qahtani, MD/MHA
Dear Dr. Durrani!
I found another article that is about this combo-treatment:
Ana, Sandoui (2020). "COVID-19: 3-drug combo treatment may be successful:
A phase II clinical trial has found that a combination of three drugs — interferon beta-1b, lopinavir-ritonavir, and ribavirin — plus standard care is successful in treating mild-to-moderate cases of COVID-19. " 11. May 2020 Medical News Today, part of Healthline Media UK
Citation: " The researchers recruited 127 participants between February 10 and March 20, 2020. These participants came from six hospitals in Hong Kong, China, where doctors had tested them for SARS-CoV-2 and obtained positive results. ... Prof. Yuen also warns that “[d]espite these encouraging findings, we must confirm in larger phase III trials that interferon beta-1b alone or in combination with other drugs is effective in patients with more severe illness (in whom the virus has had more time to replicate).” "
Available at:
https://www.medicalnewstoday.com/articles/covid-19-3-drug-combo-treatment-may-be-successful#Trial-strengths-and-limitations
May I argue that because in this trial there were no significant negative side-effects found this treatment is already a success as such! In the future the treatment only can get better and phase III will proceed: for example with a special care process developed during the III phase of trials.
Yours sincerely, Bulcsu Szekely
Hi, Dear Dr.Durrani
I am working at ICU, where intubated and extubated patients are followed. I believe that, after applying primary treatment (Oseltamivir / Hydroxychloroquine / Favipravir) for COVID-19, tocilizumab or anakinra treatments will be more effective on prognosis.
In my experience, the success rate of Lopinavir/ritonavir treatment is obviously lower compared to other second-line treatments and its combination effects are still suspicious. In this study, they didn’t use triple combination for patients who started treatment 7 days or more after symptom onset and as they explained at the end of their study, their trial was open-label and there were no placebo group.
As a result, many of the combined therapies are still in the trial phase, and their effects on pulmonary healing are not yet clear and the side effects are not yet clear.
I want to share another study about interferon beta-1 b
Can we manage prophylactic therapy in COVID-19 patients to prevent severe illness complications?
Many patients with COVID-19 have thromboembolic complications that worsen their prognosis. Herein, the authors propose a modified version of the CHA 2 DS 2-VASc score, including 1 point for COVID-19, so that prophylaxis to protect against thromboembolic events would be indicated before the condition becomes severe. The advantages of this modification would be prevention of the patient' s condition worsening due to thromboembolic problems and reduction of the likelihood of a need for intensive care and mechanical ventilation, reducing mortality.
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