COVID-19: Common drugs may worsen outcomes; one anti-inflammatory may improve them

By Paul Basilio, MDLinx
Published March 23, 2020

Key Takeaways

As of Monday afternoon, the total number of confirmed COVID-19 cases is 372,563 with 16,381 deaths globally. In the United States, the number of cases has increased to 41,708, with 573 deaths across all 50 states plus Washington, DC. State health officials reported more than 100 COVID-19–related deaths for the first time in a single day.

Worldwide, researchers are working tirelessly to study both SARS-CoV-2, the virus that causes COVID-19, and potential treatments for the disease, as well as identify drugs that may interfere with recovery from the disease.

An increased risk of severe infection

James Diaz, MD, MHA, MPH & TM, Dr PH, professor, Louisiana State University (LSU) New Orleans School of Public Health, proposes that use of ACE inhibitors and ARBs may increase the risk for poorer outcomes in patients with COVID-19. 

SARS-CoV-2 binds to ACE2 receptors in the lower respiratory tracts to gain entry to the lungs.

“Since patients treated with ACE inhibitors and ARBs will have increased numbers of ACE2 receptors in their lungs for coronavirus S proteins to bind to, they may be at increased risk of severe disease outcomes due to SARS-CoV-2 infections,” Dr. Diaz said.

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A drug to reduce complications?

Canadian researchers are studying colchicine—a powerful anti-inflammatory drug—as a means to reduce the risk of pulmonary complications and death resulting from COVID-19.

The team is hoping the drug will reduce the likelihood of a “cytokine storm,” in which the immune system releases activated immune cells that could lead to acute respiratory distress and multi-organ failure. 

Jean Claude Tardif, MD, FACC, director, Montreal Heart Institute research center, set his sights on the potential new application after it became clear that many children were resistant to the illness. Typically, children have reduced inflammatory responses to colds and influenza when compared with adults.

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Decoding the viral architecture

A team in Berlin is using high-intensity X-rays to decode the 3-D architecture of the main protease of SARS-CoV-2, which plays a central role in the virus’ reproduction.

This may allow other research teams from around the world to develop agents with activity against the virus. Knowledge of the virus’ architecture may provide specific starting points for developing active substances or inhibitors.

“For such issues of highest relevance, we can offer fast track access to our instruments,” said Manfred Weiss, MD, head of the Research Group Macromolecular Crystallography at Helmholtz-Zentrum in Berlin, Germany.

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