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Patients' Attitudes to Unproven Therapies in Treating COVID-19 Merit Evaluation.

ABSTRACT: Since the outbreak of COVID-19, many randomized controlled trials have been launched to test the efficacy of promising treatments. These trials will offer great promise for future treatment. However, a public health emergency calls for a balance between gathering sound evidence and granting therapeutic access to promising trial drugs as widely as possible. In an electronic survey, we found that 3.9% of the participants preferred to receive an unproven trial drug directly in the hypothetical scenario of mild COVID-19 infection. This percentage increased drastically to 31.1% and 54.2% in the hypothetical scenario of severe and extremely severe infection, respectively. Our survey indicates a likelihood of substantial receptivity of trial drugs among actual patients in severe conditions. From the perspective of deontological ethics, a trial can only be approved when potential benefits of the investigational treatment are presumed to outweigh risks, so compassionate or off-label use of investigational therapies merits evaluation.

SUBMITTER: Li HT

PROVIDER: S-EPMC7836536 | biostudies-literature |

REPOSITORIES: biostudies-literature

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Project description:Background and aimsVaccines are the first line of defense against coronavirus disease 2019 (Covid-19). However, the antiviral drugs provide a new tool to fight the Covid-19 pandemic. Here we aimed for a comparative evaluation of authorized drugs for treating Covid-19 patients.MethodsWe searched in PubMed and Google Scholar using keywords and terms such as Covid, SARS-CoV-2, Coronavirus disease 2019, therapeutic management, hospitalized Covid-19 patients, Covid-19 treatment. We also gathered information from reputed newspapers, web portals, and websites. We thoroughly observed, screened, and included the studies relevant to our inclusion criteria. We included only the United States Food and Drug Administration (FDA) authorized drugs for this review.ResultsWe found that molnupiravir and paxlovid are available for oral use, and remdesivir is for only hospitalized patients. Paxlovid is a combination of nirmatrelvir and ritonavir, nirmatrelvir is a protease inhibitor (ritonavir increases the concentration of nirmatrelvir), and the other two (remdesivir and molnupiravir) are nucleoside analog prodrugs. Remdesivir and molnupiravir doses do not need to adjust in renal and hepatic impairment. However, the paxlovid dose adjustment is required for mild to moderate renal or hepatic impaired patients. Also, the drug is not allowed for Covid-19 patients with severe renal or hepatic impairment. Preliminary studies showed oral antiviral drugs significantly reduce hospitalization or death among mild to severe patients. Moreover, the US FDA has approved four monoclonal antibodies for Covid-19 treatment. Studies suggest that these drugs would reduce the risk of hospitalization or severity of symptoms. World Health Organization strongly recommended the use of corticosteroids along with other antiviral drugs for severe or critically hospitalized patients.ConclusionAll authorized drugs are effective in inhibiting viral replication for most SARS-CoV-2 variants. Therefore, along with vaccines, these drugs might potentially aid in fighting the Covid-19 pandemic.

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Patients' Attitudes to Unproven Therapies in Treating COVID-19 Merit Evaluation.

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