Combined therapy (remdesivir, dexamethasone and monoclonal antibodies) for the treatment of President Trump

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Science News reported on October 5, 2020 the opinion of Rajesh Gandhi, an infectious diseases physician at Massachusetts General Hospital and Harvard Medical School in Boston on the combination therapy used for the treatment of President Donald Trump.

In the four days since revealing he had COVID-19, President Donald Trump has been treated with three experimental drugs to bring the infection under control: monoclonal antibodies, the antiviral remdesivir and the steroid dexamethasone.

Individually, all three treatments have shown promising results in clinical trials. The U.S. Food and Drug Administration has issued emergency use authorization to give remdesivir to patients ill enough to require hospitalization. Several large studies have shown steroids can reduce the risk of death in critically ill patients. And biotechnology company Regeneron Pharmaceuticals just released preliminary antibody results on September 29 from an early-stage clinical trial with 275 COVID-19 patients suggesting a high-dose cocktail of lab-made immune proteins can help speed recovery.

So far, studies suggest that remdesivir and dexamethasone can help people who end up in the hospital, Gandhi says. Remdesivir may be best used early, before patients require hospital care, but it hasn’t yet been tested in mildly ill patients. The company is working on developing an inhaled version that could be administered earlier in an infection outside of a hospital setting.

Trump received remdesivir and dexamethasone within a day or two, respectively, of his diagnosis. Such treatment may be a sign that Trump’s condition is more severe than reported, or it could be a preemptive measure to ensure his symptoms don’t become severe. Initially, his symptoms were described as mild, but his physicians have said that since his diagnosis, Trump had a fever and has received supplemental oxygen when his blood oxygen level dipped.

Researchers have made strides in uncovering potential treatments, and trials for a wide variety of drugs are ongoing. But, so far, the use of remdesivir, monoclonal antibodies and dexamethasone in combination hasn’t been studied. Some efforts are under way to find answers. Participants in the treatment arm of one clinical trial for a monoclonal antibody, for instance, are receiving both the antibody and remdesivir to compare their use together with remdesivir alone.

Because antivirals target the virus while the steroids dampen a potentially harmful immune response, such combination therapies shouldn’t overstimulate a patient’s immune system, Gandhi says. It’s unknown whether using the drugs together might help or hinder their effectiveness.  

Read the whole report here.

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