The only fully approved COVID-19 drug, the antiviral remdesivir, has shown modest benefit, at best, in hospitalized patients. Two “monoclonal antibodies” — synthetic versions of the body’s own disease-fighting antibodies — have raised hopes for keeping high-risk patients out of the hospital, but the National Institutes of Health treatment guidelines say there aren’t enough data to recommend them.
Dexamethasone, a venerable corticosteroid, is the only drug that has been shown to improve outcomes for severely ill, hospitalized patients. In those who develop clots, anticoagulants have demonstrated their value.
Meanwhile, two treatments that seemed promising — convalescent plasma and the rheumatoid arthritis drug Actemra (tocilizumab) — have been underwhelming in the latest rigorous studies.
The most encouraging [Actemra] trial found that after 14 days, 24% of patients required ventilation or had died, compared with 36% of patients receiving usual care. The other studies showed no benefit.
“Their findings do not support the routine use of tocilizumab for COVID-19 in most settings,” Jonathan B. Parr, an infectious disease specialist at the University of North Carolina, wrote in an editorial in JAMA Internal Medicine. “I plan to reconsider tocilizumab’s use if, and only if, more compelling data from randomized trials emerges.”