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New antiviral drug combo holds promise against Covid-19: study

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BEIJING: A two-week course of antiviral therapy, which was started within seven days of experiencing Covid-19 symptoms, may improve patients’ clinical recovery and reduce the length of their hospital stay, according to the first randomized trial of this triple drug combination.

The study, published in The Lancet, involved 127 adults from six public hospitals in Hong Kong, and tested the effectiveness of a combination of antiviral drugs to reduce the burden of the new coronavirus on their bodies.

According to the researchers, including those from the University of Hong Kong, treatment involving the combination of the drugs interferon beta-1b, plus antiviral therapy lopinavir-ritonavir and ribavirin, is better at reducing viral load than lopinavir-ritonavir alone. .

They highlighted the need for larger phase 3 trials to examine the effectiveness of this triple combination in critically ill patients, adding that these early findings were only seen in patients with mild to moderate disease.

The clinical improvement and length of hospital stay may be significantly shorter in people treated with the triple drug combination less than seven days after showing symptoms, compared to lopinavir-ritonavir alone, the scientists said.

According to previous studies on the flu, in which patients have high amounts of the virus in their bodies when symptoms begin to appear, they said that treating hospitalized patients with a combination of multiple antiviral drugs may be more effective than treatments with a just medicine.

According to the researchers, this can minimize the risk of antiviral resistance, and can be used as a possible therapeutic approach for Covid-19, in which the viral load also peaks at the time of symptom onset.

“Our trial shows that early treatment of mild to moderate Covid-19 with a triple combination of antiviral drugs can quickly suppress the amount of virus in a patient’s body and alleviate symptoms by reducing the duration and amount of viral shedding.” said the study. -author Kwok-Yung Yuen of the University of Hong Kong.

The treatment combination, according to the scientists, also seemed safe and well tolerated by the patients.

They said previous studies had shown that a combination of the drugs lopinavir-ritonavir, normally used to treat HIV, and ribavirin, an oral medicine for the hepatitis C virus, significantly reduced respiratory failure and death in hospitalized patients with SARS during the 2002-03 outbreak.

Developed to treat multiple sclerosis (MS), interferon beta-1b has been shown to reduce viral load and improve lung problems in animal studies of MERS coronavirus infection, the scientists added.

In the current study, they enrolled 127 adults with an average age of 52 who were admitted to one of six public hospitals with laboratory-confirmed SARS-CoV-2 infection between February 10 and March 20.

Participants were randomly assigned to 14 days of the triple combination of lopinavir-ritonavir and ribavirin orally every 12 hours, the researchers said.

These patients, who entered the hospital less than seven days after the onset of symptoms, were also injected with three doses of interferon beta-1b every other day, or lopinavir-ritonavir only every 12 hours.

The study noted that all patients received standard care, including ventilation support, dialysis support, antibiotics, and corticosteroids.

According to the researchers, the average number of days from the onset of symptoms to the start of study treatment was five days.

They evaluated the clinical course of symptoms through laboratory methods such as blood tests, chest x-rays, with regular molecular tests to detect viral load in samples of nose and throat swabs, feces, and urine tests.

Treatment with the triple drug combination effectively suppressed viral load, with no detectable virus in nasal swabs within an average of seven days of starting treatment, the researchers said.

They added that this was significantly shorter than the 12-day average in the control group treated with lopinavir-ritonavir alone.

The study also found that the 52 patients who started combination therapy (with interferon beta-1b) less than 7 days after symptom onset had better clinical and virological outcomes than the control group.

However, there was no difference in outcome between the combined treatment and the control groups in people who were treated seven days or more after showing symptoms, according to the study.

“These findings suggest that interferon beta 1-b may be a key component of combination therapy and deserves further investigation for the treatment of Covid-19,” said study co-author Jenny Lo of Ruttonjee Hospital in Hong Kong.

The researchers believe that a future phase 3 trial will confirm or refute the utility of this candidate drug as a primary treatment for Covid-19.

Citing the limitations of the research, the researchers said it was an open study in which both scientists and patients knew the treatment participants were receiving and did not have a placebo group.

They also said that the findings can be confused by the subgroup of 34 patients within the combination group who were admitted seven days or more after the onset of symptoms, and were not offered interferon beta-1b, but were analyzed as part of the combination.

“This prospective, randomized controlled design adds remarkable value to the growing evidence about treatments, removing a number of limitations inherent in retrospective studies,” said Sarah Shalhoub of Western University in Canada, who was not involved in the study.

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