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A stern warning against self-medication, new guidance from the World Health Organization (WHO), and a promising study helped make COVID treatments this week's top trending clinical topic (see Infographic below).
The US Food and Drug Administration (FDA) warned consumers against using the antiparasitic drug ivermectin to treat or prevent COVID-19. The guidance came in response to multiple reports of patients hospitalized or needing medical support after using ivermectin intended for horses and other animals. A study of 476 patients recently published in JAMA found that adults with mild COVID-19 who received a 5-day course of ivermectin did not have a shortened duration of symptoms compared with placebo. "The findings do not support the use of ivermectin for treatment of mild COVID-19, although larger trials may be needed," the authors concluded.
The WHO has published a living guideline on drugs to prevent COVID-19. The document's first recommendation states that hydroxychloroquine should not be used for prevention. A panel found strong evidence against the drug's use in patients without COVID-19, stating that "there are probably no positive effects and there was a risk of adverse effects."
In more encouraging news, a recent study of the investigational drug molnupiravir found that a single pill taken twice a day for 5 days eliminated SARS-CoV-2 from the nasopharynx of 49 participants. Carlos del Rio, MD, says that if future studies confirm similar results, molnupiravir could be taken in the first few days of symptoms to prevent severe disease, similar to Tamiflu for influenza. Still, del Rio says it is too soon to call the drug a breakthrough. "It has the potential to be practice-changing," he says, "It's not practice-changing at the moment." Phase 2/3 efficacy and safety studies are now underway in hospitalized and nonhospitalized patients with COVID-19.
Positive results were also reported from a trial of a monoclonal antibody cocktail. A one-time injection of casirivimab with imdevimab (REGEN-COV), taken within 72 hours of a household member's diagnosis with SARS-CoV-2 infection, prevented 100% of COVID-19 illness, 100% of high SARS-CoV-2 viral loads, and cut length of asymptomatic infection to 1 week. The data were presented at the virtual Conference on Retroviruses and Opportunistic Infections 2021 Annual Meeting. Because the results were based on a study with few SARS-CoV-2 infections, they did not reach statistical significance.
Peter Hunt, MD, a professor of experimental medicine, remarked that results were good enough for him to say that antibodies could change the way that public health addresses equity in the COVID-19 response as vaccines slowly roll out around the world. "The biggest role for these agents is in regions where vaccination ramp-up is slow or nonexistent," Hunt told Medscape Medical News. "We could prevent a lot of mortality — for example, in low- and middle-income countries — with these monoclonals deployed in outbreaks in congregate settings (nursing homes, jails, etc.)." That is, if future research provides similarly positive results.
Although vaccination and prevention have captured most recent headlines, interest in treatments for COVID-19 remains high, as is evident by this week's top trending clinical topic.
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Cite this: Ryan Syrek. Trending Clinical Topic: COVID Treatments - Medscape - Mar 19, 2021.