As the COVID-19 pandemic shut down the planet, medical experts and scientists around the world have found themselves in an unprecedented race to find a treatment for the disease.
“At this time, there are no medical therapies that have been definitively shown to improve outcomes in patients with COVID-19,” said, Dr. Marissa Alejandria, director of the Institute of Clinical Epidemiology of the UP Manila National Institutes of Health, professor at the UP College of Medicine, and president of the Philippine Society for Microbiology and Infectious Diseases.
Speaking during the third installment of the UP webinar series, “Stop COVID Deaths: Clinical Management Updates” held on May 8, which focused on “The Treatment Landscape of COVID-19”, Dr. Alejandria reports that a number of drugs currently being studied around the world have demonstrated in vitro activity against the SARS-CoV-2 virus or have demonstrated potential clinical benefits in observational or small, non-randomized studies. She also presented clinical data on four antiviral drugs being used to treat COVID-19: chloroquine or hydroxychloroquine, lopinavir-ritonavir, remdesivir, and favipiravir.
“We have no drug that has been really approved, no effective antiviral therapy at this time,” she said. “The studies raised optimism, but we all know the limitations of observational studies and case series without a control group, so we don’t know if it’s the drug that resulted in a clinical benefit or if it is due to host factors or a combination of interventions. We still need clinical trials.”
Adequately powered randomized clinical trials are currently enrolling and are needed to establish the efficacy of these proposed therapies. One is the World Health Organization (WHO) SOLIDARITY Trial, which aims to test the safety and effectiveness of the four possible therapies in treating COVID-19 compared to standard of care. The Department of Health announced the participation of the Philippines in this last April 22, with Dr. Alejandria as country representative leader. Other randomized clinical trials around the world are the Anti-Coronavirus Therapies to Prevent Progression of Coronavirus Disease 2019 Trial or ACT COVID19; and the Adaptive COVID-19 Treatment Trial or ACTT.
For now, when it comes to the management of COVID-19 patients, the standard of care in the country is delivering best supportive care while the body battles the virus: treatment of symptoms, hydration, antibiotics for bacterial pneumonia, oseltamivir for influenza, and for patients with severe or critical cases, intensive respiratory management and intensive care support.
However, there is another way that patients and medical workers can contribute to the race to defeat COVID-19. “The priority should be to enroll the patient, if they qualify, in a clinical trial [of the investigational drugs], if these do not have the contraindications that would cause harm to the patient,” said Alejandria.
Patients who are stable or who do not have evidence of oxygen requirements or pneumonia can generally be managed with supportive care alone. But patients with hypoxia or pneumonia, especially those with risk factors, can be considered for a specific COVID-19 therapy after discussing the risks and benefits with their doctors and giving their informed consent, in accordance with local hospital treatment guidance.
“Now that we have the WHO Solidarity Trial in the country, there is an option for the clinician to enroll the patient into the clinical trial rather than just outright giving chloroquine, lopinavir or tocilizumab,” said Alejandria. “It would be a benefit to science if we are able to contribute to this clinical trial to be able to answer the question on which antiviral treatments are effective for COVID-19.”
“As of today, we have 63 enrolled patients, with hospitals contributing to the trial, number of patients being enrolled per day,” said Alejandria. There are 24 site hospitals in the country participating in the trial, including nine government hospitals, one of which is the UP Manila Philippine General Hospital, and 15 private hospitals. “We hope to be able to contribute more. This is not a race against each other, but a race against time to find the effective drug that will hopefully end this pandemic.”
The UP “Stop COVID Deaths: Clinical Management Updates” webinar series taps into the experiences of clinicians, hospital administrators, and researchers with the goal of protecting the health systems against COVID-19 by bridging the gap between knowledge and practice in the clinical management of cases in the Philippines. This webinar series is produced by the University in partnership with the National Telehealth Center and the Philippine Health Insurance Corporation.
The fourth webinar in the series, set for May 15 at 12:00 noon, will tackle the impact of COVID-19 on the other parts of the body, specifically the kidneys. Dr. Elizabeth Montemayor, Professor, UP College of Medicine, and Vice President, Philippine Society of Nephrology, will be the speaker.