New COVID-19 Pill Treatment May Be Promising – Cleveland Clinic


When you do get sick, there are many treatment options to help you get better. For a bacterial infection, doctors may prescribe antibiotics. A seasonal respiratory virus, such as a cold or the flu, can be treated with fluids, rest, and over-the-counter medications designed to treat your symptoms.

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For people diagnosed with serious conditions such as COVID-19[female[feminine, which is caused by the SARS-COV-2 virus, other types of medicines may be helpful. Common treatments prescribed to date include monoclonal antibodies and convalescent plasma.

“The rationale for these treatments is that we use antibodies that combine with parts of viral cells,” says an intensive care doctor. Abhijit Duggal, MD. “By attaching to the cell and impacting the shape of the cell, these antibodies will minimize the ability of the virus to go out and cause problems.”

Over the years, however, doctors have started to develop antiviral drugs to treat certain conditions. For example, on December 22, the Food and Drug Administration (FDA) released a emergency use authorization (EUA) for a pill developed by Pfizer to treat mild to moderate COVID-19. These antivirals differ significantly from antibody-related treatments.

What are antiviral pills?

A virus is made up of genetic material surrounded by a capsid or a protective envelope made up of proteins. To reproduce, viruses sneak into cells in your body, then use that space as an incubator to make more copies of themselves. However, if this process is interrupted or disrupted at any point, the virus will stop replicating itself.

This is the purpose of antiviral pills. They go straight to the source – the viral cells – and interrupt their usual activities. “Antiviral pills either work directly on the virus itself and disrupt the virus’ reproductive cycle – which means the virus cannot replicate – or cause direct damage to the virus, where you decrease its effectiveness,” Dr Duggal said.

Antiviral pills are already used to treat HIV, hepatitis B and hepatitis C. Tamiflu, which you may have taken after getting the flu, is also an antiviral. More recently, an antiviral drug called remdesivir was initially used to treat COVID-19.

How do antiviral pills work?

Your body is made up of many building blocks, including proteins called enzymes. An enzyme known as a protease is responsible for breaking down other proteins, such as those used to help viruses replicate.

Antiviral pills contain protease inhibitors. Put simply, these protease inhibitors turn off the specific protease enzyme (or protein) that allows a virus to function normally, that is, to reproduce, in your body. “Protease inhibitors have been used in drugs to treat other viral diseases for some time,” says Dr Duggal. “Protease inhibitors act on specific aspects of virus protein development.”

What are COVID-19 antiviral pills?

However, not all antiviral pills are one-size-fits-all. “The problem is, you have to figure out which chemical is going to disrupt the protein associated with the specific virus itself,” says Dr Duggal. For example, drugs used to treat HIV are calibrated specifically for these viral proteins.

When it comes to COVID-19 pills, Pfizer developed theirs specifically to fight a protease called 3CL, which is associated with SARS-COV-2. “This drug disrupts the development of this protease,” explains Dr. Duggal. “By doing this, the viral cell will not be able to maintain itself. When its replication stops, you are essentially removing the total number of cells.

Many antiviral drugs combine several protease inhibitors. For example, the Pfizer COVID-19 pill combines two of them: ritonavir, which has been used to fight viral diseases such as HIV and Hepatitis B, and a new protease inhibitor, nirmatrelvir, developed by Pfizer. By working together, these protease inhibitors appear to help lower the overall viral load in your body.

Who should take the COVID-19 antiviral pills?

Even though these antiviral pills have been approved for emergency use by the FDA as a COVID-19 treatment, they are not suitable for everyone. According to the FDA, prescription-only pills are “for the treatment of mild to moderate coronavirus disease (COVID-19) in adults and pediatric patients (12 years and older weighing at least 40 kg or about 88 pounds)) with positive direct test results for SARS-CoV-2, and who are at high risk of progression to severe COVID-19, including hospitalization or death. ”

In other words, you won’t be using them to prevent yourself from catching the virus. “The way to think about these drugs is that it looks like if you’ve been exposed and now potentially develop the disease, or are at a higher risk of developing the disease due to exposure to the virus, they decrease your risk quite significantly. Said Dr Duggal.

“Think of them as post-exposure medication that you take to make sure you don’t develop viral titers (concentration levels) high enough that you have a bad infection or serious illness. Your primary prevention would still be if you were vaccinated because your risk will definitely be much, much lower than anything else. “

The reason you just don’t want to start taking COVID-19 pills “just in case” you might get sick is that viruses can become resistant to drugs. “Drug resistance is always a problem,” says Dr Duggal. “Even in other illnesses, when you use antivirals you have to be very careful about how you use them so that you don’t develop resistance to them. You want to keep these drugs for the people who really need them. If people just start taking pills in the hopes that it will reduce their risk, the risk of the virus developing resistance to that pill will increase very, very quickly. And the risk of that becoming ineffective would be a huge problem for us at that point. “

Viral mutations are also always present as new drugs are developed. “Viruses are smart,” says Dr Duggal. “Viruses are actively mutating. They change their structure in specific ways where the things we use to influence them diminish. “

If a new variant comes along that now has a mutation, it is possible that these drugs may not be as effective or work at all, notes Dr Duggal. This is what we are seeing with SARS, and it is not unusual. “With most respiratory viral diseases, the risk of mutation is much higher than other viruses,” says Dr Duggal. “That’s why it’s getting a lot harder to deal with. And it’s such an active evolving situation with such a high disease burden, so the risk of mutations is always going to be higher.”

Dr Duggal adds that because the COVID-19 pills now approved for emergency use are based on protease inhibitors, these drugs should be in a better position to manage viral mutations. “When we talk about these protease inhibitors messing with something and it just stops working, that’s good,” he says. “It is difficult for the virus to mutate very quickly at the cellular level. It is possible, but it will obviously be much more complex. However, Dr Duggal once again emphasizes that these pills should always be reserved for people who really need them. “The virus is more likely to develop resistance the more you expose the virus to these pills.”

Getting vaccinated is important

Antiviral pills to treat COVID-19 are not a substitute for vaccination.

Right now, getting the vaccine is the most crucial step you can take, as trying to disrupt the overall virus replication cycle through herd immunity is the best way to bring the pandemic under control. Along with this, Dr Duggal recommends proven methods to keep the virus at bay, such as masking, social distancing, and hand washing.

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