A combination drug therapy for COVID-19 aims to both prevent the virus from spreading inside the human body as well as quelling the immune system havoc that the germ wreaks.
A U.S. federally funded clinical trial is testing whether the experimental antiviral drug remdesivir works better against COVID-19 if given with a powerful anti-inflammatory drug called baricitinib.
"Baricitinib is a once-daily oral drug that has been well-tolerated in many studies examining its use in rheumatoid arthritis. It has very few drug interactions, so can it be combined with most antivirals such as remdesivir," said Dr. Vincent Marconi, a professor of medicine and global health at Emory University School of Medicine in Atlanta.
This isn't the only study looking at combining remdesivir with another drug.
The Washington state-based biotech firm CytoDyn is preparing a clinical trial that would combine remdesivir with leronlimab, a drug that inhibits viral infection and also has shown some anti-inflammatory effects, the company announced this week.
Why add other drugs to a remdesivir regimen? Remdesivir has been shown to stop the COVID-19 coronavirus from multiplying in humans, but its effect in improving patients' health has been "modest," said Dr. Richard Novak, head of infectious disease research with the University of Illinois at Chicago.
Researchers suspect that might be because the antiviral drug does nothing to counter the immune system's extreme reaction to COVID-19 in severe cases -- a wave of intense inflammation that damages organs and contributes to pneumonia.
"Remdesivir has a marginal benefit and is getting people better quicker," said Dr. Amesh Adalja, a senior scholar with the Johns Hopkins Center for Health Security. "However, there are immunological issues that occur with infection that may be responsible for some of the severe manifestations of COVID-19."
Research teams are hopeful that adding baricitinib to remdesivir will more effectively treat COVID-19, saving lives and returning people to good health sooner.
Novak's team at UIC just enrolled their first patient in the remdesivir/baricitinib trial, which is being funded by the U.S. National Institute of Allergy and Infectious Disease and is called the Adaptive COVID-19 Treatment Trial, or ACTT.
The first phase of ACTT focused on remdesivir alone now baricitinib will be added to the mix. In the future, the trial might also test combinations of remdesivir with other drugs, Novak said.
The goal is to enroll between 800 and 1,000 participants in this phase of the trial, at as many as 100 different hospitals around the world, Marconi said. Eligible patients must be hospitalized with COVID-19 and suffering from lung-related complications.
Everyone in the trial will be treated with remdesivir, but will be randomly chosen to receive either baricitinib or a placebo in addition to the antiviral drug, Novak said.
"The good thing is we now have a supply of compassionate-use remdesivir. People who come in who need to be treated, we have drugs for them," Novak said.
This multiple-drug approach takes its cue from previous AIDS research, where experts found that drug cocktails could prevent the spread and progression of HIV.
The U.S. Centers for Disease Control and Prevention has more on COVID-19.
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