Antiviral drugs in coronavirus: facts and responsible pharmacological counseling

Coronavirus continues to set the tone for sales in pharmacies. Over-the-counter drugs that stimulate immunity are in high demand. These are the well-known Arbidol, Ingavirin, Cycloferon, Kagozel, Ergopheron, Trekrezan, Amixin with brothers, Triazavirin and others. These drugs bring a large share of income, are sold easily, because they practically do not require a recommendation: they are known about them thanks to advertising campaigns. It is also very convenient that these drugs, according to the instructions, help fight the whole range of influenza and ODS viruses. The essence of the action is as follows: you need to activate your immunity and your body can cope with viruses, including the SARS-CoV-2 virus. It makes sense. But is it really so?

At present, this group of drugs remains controversial. According to Alexander Khadzhidis, chief clinical pharmacologist of St. Petersburg, we do not have immunomodulatory drugs for treatment of ODS with proven efficacy, as well as worldwide. However, this does not mean that the drugs cannot work in principle. It means that in order to prove their effectiveness, strict controlled clinical trials on a large number of people must meet certain requirements.

In addition, medical scientists in St. Petersburg suggest that the use of “immunomodulators” for severe viral infections, including coronavirus infection, may not be safe. Coronavirus infection may cause potentially fatal uncontrolled activation of the immune system – a cytokine storm, which actively releases interferons, interleukins, tumor necrosis factors, chemokines and some other inflammatory mediators. Therefore, theoretically, additional stimulation of immunity in case of coronavirus infection may be dangerous.

As they say, there should be no opinions in medical science, but facts. Therefore, we have collected factual information on the three actively sold drugs from this group.

Umifenovir

Antiviral drugs in coronavirus: facts and responsible pharmacological counseling

According to the instructions for the active ingredient, the drug is able to inhibit coronavirus (SARS-CoV) associated with severe acute respiratory syndrome (SARS) in vitro. The SARS-CoV virus causing SARS, although it comes from the same family as the SARS-CoV-2 virus, is an independent representative.

A recent retrospective study conducted at Jingyitan Hospital in China showed no connection between the use of umifenovir and the improvement of COVID-19 treatment results.

In another randomized study, again in China, evidence was obtained that monotherapy with umifenovir has little advantage over the lack of monotherapy. The group of patients taking Umifenovir noted undesirable effects while the control group did not have them.

Indian company Glenmark Pharmaceuticals announced the results of its study with Umifenovir: adding Umifenovir to Favipiravir therapy did not show the best clinical results. The study enrolled 158 hospitalized patients with medium severity COVID-19.

Umifenovir is currently the only member of the group to be included in the Ministry of Health’s interim guidelines for the prevention, diagnosis and treatment of new coronavirus infection, with the caveat that it is impossible to draw an unambiguous conclusion about the efficacy or ineffectiveness of Umifenovir and other etiotropic agents.

In the dry residue: available studies on umiphenyovir are not sufficient to assess its efficacy against the SARS-CoV-2 virus.

Vitaglutam

Antiviral drugs in coronavirus: facts and responsible pharmacological counseling

Ingavirin has been registered with this active substance. Advertising during the pandemic focused on the effectiveness of the drug against coronavirus. In the instructions of the drug itself we can see that the drug showed effectiveness in relation to coronavirus in preclinical studies.

The manufacturer’s website specified that NL63 and SARS strains were meant, and that additional studies would be required for a new strain of coronavirus. It is likely that SARS refers to the previously known coronavirus SARS-CoV. This information has now been removed from the website.

In May, the Ministry of Health, the Federal Antimonopoly Service of the Russian Federation and the manufacturer were asked to clarify the evidence base and comments on the above. The answers have not been published yet.

In the dry residue: clinical trials of this drug on its use for prevention and treatment of COVID-19 have not yet been announced.