Importance of Clinical Trials in COVID-19 Treatment

Synopsis: Clinical Trials have been instrumental in the development of treatment for Covid-19 so far.

Introduction

The World Health Organization (WHO) declared the SARS-CoV-2 pandemic on March 11, 2020. Doctors did not know how to treat patients with COVID-19 in the beginning. Clinical care was dominated by opinion, narratives, and code of belief in the first few months.

  • For example, it was believed that hydroxychloroquine could cure COVID-19. The truth is hydroxychloroquine does not benefit COVID-19 patients. 
  • After one year, many medicines which do not cure Covid-19 are still in use, such as steam inhalation, multivitamins, mineral supplements, ivermectin, and chloroquine, etc.
How the clinical trials helped in finding the best treatment?

Clinical trials are important for finding the best treatment. Doctors treated symptoms and provided life support until these trials produced results.

  1. Firstly, many COVID-19 patients developed blood clots and treated with blood-thinning medications. Other treatments included oxygen, breathing support ventilators for severely ill patients, kidney dialysis, and supporting heart with blood pressure medications.
  2. Secondly, COVID-19 demanded for producing high-quality evidence quickly. There was a requirement for designing trials to test many treatments at once with innovative designs such as platform trials and adaptive trials.
    • For example, The RECOVERY trial network in the U.K., the REMAP-CAP trial globally focusing on critically ill patients, and the WHO-led SOLIDARITY trial.
    • RECOVERY verified that there was no benefit of using hydroxychloroquine, azithromycin, lopinavir-ritonavir, colchicine, and convalescent plasma.
    • REMAP-CAP found that hydroxychloroquine and lopinavir-ritonavir were harmful to use. It proved that there is no benefit with convalescent plasma.
    • SOLIDARITY highlighted the lack of benefit of Remdesivir. It is an antiviral drug that possibly shortens the illness duration.
  3. Thirdly, it is important that the results of these clinical trials should be interpreted into clinical practice by healthcare professionals managing COVID-19 patients.
What are the drugs that have been proven to benefit COVID-19 patients?
  1. Firstly, Corticosteroid (dexamethasone) is effective in COVID-19 patients who require oxygen and in severely ill patients (hydrocortisone). 
  2. Secondly, two interleukin-6 receptor blocking drugs (tocilizumab and sarilumab) benefit COVID-19 patients. They show enhanced results used in combination with corticosteroids, specifically in patients with moderate and severe COVID-19.

What should be done? 

  • Thus, clinical trials show that apart from supportive care (oxygen, ventilatory support), the only drugs that reduce mortality are steroids and interleukin-6 receptor blocking drugs. Thus, random drugs without proper clinical trial, need to be avoided 

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