COVID-19: Common Drugs May Worsen Outcomes; One Anti-Inflammatory May Improve Them


 
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By Paul Basilio

As of Monday afternoon, the total number of confirmed COVID-19 cases is 372,563 with 16,381 deaths globally. In the United States, the number of cases has increased to 41,708, with 573 deaths across all 50 states plus Washington, DC. State health officials reported more than 100 COVID-19–related deaths for the first time in a single day.

Worldwide, researchers are working tirelessly to study both SARS-CoV-2, the virus that causes COVID-19, and potential treatments for the disease, as well as identify drugs that may interfere with recovery from the disease.

An increased risk of severe infection

James Diaz, MD, MHA, MPH & TM, Dr PH, professor, Louisiana State University (LSU) New Orleans School of Public Health, proposes that use of ACE inhibitors and ARBs may increase the risk for poorer outcomes in patients with COVID-19.

SARS-CoV-2 binds to ACE2 receptors in the lower respiratory tracts to gain entry to the lungs.

“Since patients treated with ACE inhibitors and ARBs will have increased numbers of ACE2 receptors in their lungs for coronavirus S proteins to bind to, they may be at increased risk of severe disease outcomes due to SARS-CoV-2 infections,” Dr. Diaz said.

Diaz writes, this hypothesis is supported by a recent descriptive analysis of 1,099 patients with laboratory-confirmed COVID-19 infections treated in China during the reporting period, December 11, 2019, to January 29, 2020. This study reported more severe disease outcomes in patients with hypertension, coronary artery disease, diabetes, and chronic renal disease. All patients with the diagnoses noted met the recommended indications for treatment with ACEIs or ARBs. Diaz says that two mechanisms may protect children from COVID-19 infections—cross-protective antibodies from multiple upper respiratory tract infections caused by the common cold-causing alpha coronaviruses, and fewer ACE2 receptors in their lower respiratory tracts to attract the binding S proteins of the beta coronaviruses.

He recommends future case-control studies in patients with COVID-19 infections to further confirm chronic therapy with ACEIs or ARBs may raise the risk for severe outcomes.

In the meantime he cautions, "Patients treated with ACEIs and ARBs for cardiovascular diseases should not stop taking their medicine, but should avoid crowds, mass events, ocean cruises, prolonged air travel, and all persons with respiratory illnesses during the current COVID-19 outbreak in order to reduce their risks of infection."

A drug to reduce complications?

Canadian researchers are studying colchicine—a powerful anti-inflammatory drug—as a means to reduce the risk of pulmonary complications and death resulting from COVID-19.

The team is hoping the drug will reduce the likelihood of a “cytokine storm,” in which the immune system releases activated immune cells that could lead to acute respiratory distress and multi-organ failure.

Jean Claude Tardif, MD, FACC, director, Montreal Heart Institute research center, set his sights on the potential new application after it became clear that many children were resistant to the illness. Typically, children have reduced inflammatory responses to colds and influenza when compared with adults.

If it proves to be successful, the drug—which is already used to treat gout and pericarditis (inflammation of the heart membrane), and is readily available and inexpensive—could become a key tool in the pandemic fight.

Tardiff told public broadcaster Radio-Canada that he hopes to know if it works within 3 months.

He said he became interested in its possible application as a COVID-19 fighter when it became clear that most children were resistant to the illness.

Children typically have reduced inflammatory responses to colds and flus, compared to adults.

In laboratory tests, animals whose inflammatory responses were blocked also lived longer when exposed to influenza.

One hundred and 25 people worked on the hypothesis and Health Canada approved the Quebec government-funded study within 24 hours.

According to a heart institute statement, the researchers are looking to recruit 6,000 Canadians with the coronavirus, for a clinical trial.

There were 1,430 cases of COVID-19 confirmed in Canada as of 2200 GMT Sunday, including 20 deaths.



 
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