Ronapreve, molnupiravir, tocilizumab… These barbaric names probably don’t mean anything to you. Yet they could represent an important turning point in the fight against the coronavirus. Especially with the emergence of new variants (including the Mu variant which could counteract the action of vaccines) and the fact that some rich countries are reaching a glass ceiling on the vaccination side … Especially since the World Health Organization fears that vaccination is not enough to overcome the pandemic. Good news, many researchers are working on the other arm necessary to counter the pandemic: treatments.
If today, corticosteroids have been proven, reducing mortality by 21%, other treatments, by injection or not, could appear in the coming months. Which ones arouse the most interest?
Ronapreve extended to certain hospital patients
There is something new in this fall. First of all, on the Ronapreve side. It is a treatment combining two monoclonal antibodies (casirivimab and imdevimab), injected with a syringe. From which Donald Trump had benefited in October 2020. “It was designed directly to target and bind to part of the Spike protein and prevent the virus from entering human cells”, explains Nathan Peiffer-Smadja, infectious disease specialist at the Bichat hospital (AP-HP). And so that the patient, fragile and hospitalized, finds himself in intensive care.
This treatment, developed by the American biotech Regeneron and the Swiss laboratory Roche, is already available in France. “Since the end of March 2021, it has been prescribed only for people at risk of progressing to a severe form and in the first five days after the onset of symptoms”, specifies Yazdan Yazdanpanah, infectious disease specialist, director of the National Research Agency on AIDS (ANRS) and member of the Scientific Council on Covid-19. In August, access was extended to people who have not developed antibodies [pas de vaccin ou mauvaise réponse au vaccin], as soon as they come into contact with an infected person. “
This access was once again extended. Since September 3, hospitalized patients can benefit from it, provided that they are on oxygen, that they have no antibodies (no vaccine or poor response to the vaccine) and that they have a risk of a serious form. Concretely, these are people who are immunocompromised, suffering from diabetes, obesity, COPD (chronic obstructive pulmonary disease), heart or kidney failure and those over 80 years old.
Why this enlargement? “Shortly before the summer, positive results were recorded for patients already hospitalized, within the framework of the large European clinical trial Recovery”, explains Yazdan Yazdanpanah. Another reason: another monoclonal antibody treatment, that of Eli Lilly, also given to very vulnerable people, is no longer effective against the Delta variant. “While Ronapreve is,” says the infectious disease specialist. It is therefore additional protection for the most vulnerable, especially people with transplants or those undergoing treatment for cancer.
Two other promising injection treatments
Another injection treatment of interest to health authorities: tocilizumab. It is again Roche who is in the driver’s seat for this treatment called Roactemra and already used to fight rheumatoid arthritis. The European Medicines Agency (EMA) announced in mid-August that it would assess the effectiveness of tocilizumab in treating severe forms of Covid-19. And report its results in October 2021.
Finally, there is a little French that could soon arrive on the market. The Nantes laboratory Xenothera has developed an injection treatment based on polyclonal antibodies, called Xav-19. He too is eagerly awaited: as proof, France has pre-ordered 30,000 doses. According to The world, it could be available this fall.
“But these are intravenous treatments, nuances the director of the ANRS. The next step is to have oral treatments, which are easy to take. However, various drugs are being evaluated, we will know more in October. “
Expected results for oral treatments
What are the treatments on the rails? Much attention has been paid to Molnupiravir. The Merck laboratory is currently carrying out phase 3 clinical trials for this pill, which would prevent the virus from multiplying in our cells. Promising results showed that the viral load disappeared in infected patients after five days. “But this summer, trials in hospitalized patients have shown no effectiveness,” nuance Nathan Peiffer-Smadja.
Obviously, other laboratories are positioning themselves in this niche. In particular Pfizer, the big winner of the vaccine race. The American laboratory has been testing a pill, PF-07321332, since March 2021, which will counter the action of protease, an essential enzyme in the multiplication of the coronavirus. On September 2, Pfizer announced that it was launching phases 2 and 3 (run in parallel to save time) of the clinical trial involving 1,140 people. With a specificity: we seek to see the effectiveness and the possible undesirable effects in non-hospitalized patients and presenting a low risk of progression towards a serious disease. If the trial were to prove conclusive, we could therefore imagine, in a few months, having a drug useful for the entire population, at the first signs of Covid-19. There is therefore no more risk of seeing our hospitals embolized …
“We have never found a cure for the flu”
Science fiction? Not necessarily, even if the researchers remain cautious. “We hope that at last we will have a treatment that works on the virus, breathes Yazdan Yazdanpanah. There is very important research at the moment to expand the therapeutic arsenal. Without hiding that the challenge remains immense. “It’s very complex to have an effective treatment against viruses,” he continues. We have never found any for the flu … “” Nor for dengue, HIV, chikungunya, adds Nathan Peiffer-Smadja. We treat bacteria, parasites and fungi well. But since the virus uses our cells to reproduce, it must be destroyed without damaging our cells. “