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Coronavirus patient at UCSF gets a two-drug combo in a global experiment



Researchers at UCSF have begun testing a mix of two of the most promising treatments for COVID-19 in the hope that the concoction is the “golden ticket” everyone is looking for to neutralize the coronavirus and relieve anxiety in the world.

The doctors conducting the study, sponsored by the National Institutes of Health, treated their first patient last week with a combination of remdesivir, an antiviral drug developed to treat Ebola, and interferon, an anti-inflammatory used for people with multiple sclerosis.

The hope is that, together, the two drugs will reduce the length and severity of the disease and reduce the number of deaths caused by SARS-CoV-2, the specific coronavirus that causes COVID-1

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“We are looking for a gold ticket,” said Peter Chin-Hong, a professor of medicine and infectious disease at UCSF, who is on the study team. “The gold medal is a combination of drugs that will take you to the sweet spot.”

This is the third phase of NIH-sponsored drug trials seeking a curative cocktail, such as combining treatments used by HIV-AIDS patients to control the infection. Researchers expected to develop an effective drug treatment for COVID-19 at the end of the year.

Remdesivir, produced by Foster City’s Gilead Sciences, interferes with the process by which the coronavirus replicates itself. A large study led by the federal government triggered the turmoil in late April when hospitalized patients who received remdesivir intravenously recovered more quickly than those who received a placebo.

Doctors have been using remdesivir to treat seriously ill patients ever since. The problem is that there is conflicting evidence as to whether remdesivir reduces the number of deaths, so “this is not a gold medal in my Olympics drug,” Chin-Hong said. “It’s a silver medal.”

That is where beta interferon enters, he said. A recent study in the United Kingdom showed hospitalized people who inhaled interferon like an asthma drug recovered faster. He said the preliminary study, which had not been evaluated by the peer, showed an 80% decrease in both deaths and the number of patients in the respiratory tubes compared to people on a placebo.

Interferon has also been reported to have worked in laboratory studies on SARS, a coronavirus identified in 2003 in China, and MERS, discovered in Saudi Arabia in 2012. Viral respiratory diseases cause similar symptoms in people infected with SARS-CoV-2.

An added benefit, Chin-Hong said, is that interferon is readily available, relatively inexpensive and can be given to patients at home.

“That’s why interferon is the darling today,” he said.

The plan is to enroll patients at UCSF and some 100 other places around the world. 1,000 or so patients in the study were given a remdesivir infusion. Half will be injected with interferon, while the other half will get a placebo. Researchers then study how patients react to each group over time.

The combination is necessary, Chin-Hong said, because remdesivir is designed to attack the virus, while interferon reduces inflammation. The inflammatory response, known as a cytokine storm, is a serious problem in COVID-19 patients whose immune systems overflow with disease, worsening lung infections and other organs.

If the two drugs work properly, researchers think they can use them as an outpatient treatment that can prevent hospitals. Gilead Science is studying a nebulized formula of remdesivir that can be inhaled at home.

“It means I have something I can give to patients that will reduce hospitals, reduce mortality and reduce the need for a breathing tube,” Chin-Hong said. “All those things will make me happy.”

Art Reingold, a professor of epidemiology at the UC Berkeley School of Public Health and not intrigued by the study, warned against taking someone’s expectations too high.

“It would be nice if it worked,” Reingold said. “But there are many things that are not.”

John Swartzberg, an infectious disease expert at the UC Berkeley School of Public Health, is frustrated with the potential benefits of the combination of the two drugs. This is “perhaps a beacon of hope for the sick from COVID-19, (but) it is certainly not a game changer,” he said. “What we need is something on the other end of the COVID-19 spectrum: an oral med taken at the first signs of illness or after exposure. That would be a game changer!”

The two drugs not only showed promise. The steroid dexamethasone significantly reduced deaths in critically ill COVID-19 patients during a recent drug trial conducted by the University of Oxford. That finding marked the first time any coronavirus treatment had been proven to prevent death.

Chin-Hong said remdesivir, dexamethasone and other treatments and procedures developed during the pandemic have reduced deaths in hospitals across the country, offering hope and an incentive to intensify search for more effective treatment.

Peter Fimrite is a staff writer for the San Francisco Chronicle. Email: pfimrite@sfchronicle.com. Twitter: @pfimrite




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