Recently, Russia has registered many new drugs against coronavirus. The World Health Organization considers dexamethasone to be the only drug with proven effectiveness against Covid-19. It is available in Russia, but it helps only in severe cases of the disease.
What other medications can help treat Covid-19 and which are available in Russia? In addition to dexamethasone, the Russian Ministry of Health recommends the use of favipiravir, hydroxychloroquine and the antibiotic azithromycin for the treatment of Covid-19. The recommendations also include immunomodulators based on interferon-alpha and umifenovir, known as “Arbidol”. There are also several lesser-known medications for the treatment of patients with moderate and severe forms of the disease.
The available information on the results of therapy with all these drugs does not allow to draw a final conclusion about their effectiveness, the Russian Ministry of Health honestly states. Therefore, their use can be decided by the medical commission only if it believes that the potential benefit for the patient justifies the possible risks.
In early October, Moscow authorities announced that they would provide free medications to residents with confirmed coronavirus infections who are being treated at home. Patients with pneumonia will also receive pulse oximeters (devices that measure oxygen saturation in the blood), and patients with moderate disease severity will receive anticoagulants (drugs that prevent the formation of blood clots), according to the city government. Moscow also promised to provide the recently registered drugs “Alepivir” and “Coronavir” free of charge to those being treated at home.
Russians often talk on social networks about their discovery of the coronavirus in themselves, what they did next, and the actions of doctors. From several BBC posts found on social networks of residents of Moscow and St. Petersburg, it can be inferred that doctors often prescribe them “Arbidol” (cost from 300 to 700 rubles) and “Grippferon” (300-600 rubles in pharmacies), as well as “Ingavirin” (from 500 to 800 rubles per pack).
“Arplivir” is one of the three drugs registered in Russia with the active ingredient favipiravir. The latter is not included in the recommendations of the Ministry of Health. This drug is registered in Russia as an anti-influenza drug, but the effectiveness of “Ingavirin” against any virus is not proven. In Europe and the USA, drugs based on this substance are not registered. There are questions about its effectiveness studies – they were conducted in Russia, often by the same group of authors, often in cooperation with the drug developer.
A Moscow resident who recently recovered from a mild case of coronavirus at home told the BBC that his doctor prescribed the antibiotic chemomycin (azithromycin), even though he had no confirmed bacterial infection.
We explain quickly, simply, and clearly what happened, why it matters, and what happens next. Episodes End of story: Podcast Advertising. The Muscovite recipe (available at the BBC) also includes the anti-influenza drug “Tamiflu”. This drug is included in the list of essential medicines by the WHO, but in 2017 its status was downgraded to “supplementary”. This drug is widely used in the USA, but there is currently no data on its effectiveness against Covid-19. Also in the doctor’s prescription it says “Galavit”. According to the manufacturer, this drug has immunomodulating and anti-inflammatory activity. However, there are no documents related to the active substance of this drug found in the international database of medical research publications. The doctor also prescribed the Moscow immunomodulating drug “Ingaron” in the form of nasal drops. In the post-Soviet space, such immunomodulators in the form of drops, ointments or candles are popular. However, according to the WHO, there is no evidence that topical interferon is effective in treating influenza. No such data are currently available for the new coronavirus infection.
Among the drugs recommended by the Ministry of Health is favipiravir. In international clinical recommendations, this drug is currently considered not to have proven its efficacy. It is registered in Japan and France, but in Japan the patent expired last year. In May 2020 it was registered in Russia. Currently, there are three drugs registered in the country with this active ingredient: “Avifavir, Areplivir and Koronavir. In late September, pharmacies began selling the last two – the retail price for a five-day course of “Areplivir” was then 12,320 rubles ($160), and “Koronavir” was 11,550 rubles ($150). In October, “Avifavir” was put on sale – its price for the same doses was already about 8,000 rubles (105 dollars). The instructions for the drugs state that the course of treatment lasts for 10 days or until the virus disappears from the body. Therefore, to complete a full course of treatment, you need to buy two packages of drugs. The price of one package is comparable to the minimum wage in Russia, which will be 12,130 rubles per month in 2020. Favipiravir was later classified as a vital and essential drug (VED), whose prices are regulated by the state. In October, the Federal Antimonopoly Service reported that the maximum retail price for favipiravir drugs, including VAT, will be 100 rubles per tablet or 5,500 rubles per package. The maximum cost of the drug, including regional surcharges, will be 6,875 rubles, according to the FAS. “Arepilvir” can already be found in Moscow pharmacies for 5,500 rubles. The drug is approved for outpatient use for mild disease progression – meaning that the patient can receive medication from a doctor in a clinic and self-manage it at home. When treated with this medication, women are advised to use “the most effective methods of contraception” as it may cause disruptions in the intrauterine development of the child. After discontinuing the use of this medication pregnancy should not be planned for three months.
Scientists have not reached a clear conclusion about the effectiveness of favipiravir. Favipiravir was originally developed in Japan as an anti-influenza drug and is marketed under the brand name Avigan by Fuji. In July, Japanese scientists from Fujita Medical University found no evidence of favipiravir’s effectiveness in the early stages of coronavirus infection. The study involved 89 patients from Japan in the early stages of the disease or without pronounced symptoms. “Although the well-being of patients who received the drug early in the study improved more than that of patients who started the drug later, the results did not reach statistical significance,” the study said.
According to the interim results of the WHO-sponsored “Solidarity” program, there was no significant reduction in Covid-19 mortality or hospitalization time for patients with a confirmed diagnosis of a new coronavirus infection when remdesivir, hydroxychloroquine, and interferon were used. As part of the study, WHO tested the effectiveness of four possible treatment options: remdesivir, hydroxychloroquine, interferon, and a combination of lopinavir and ritonavir (the latter therapy has already been excluded from the Ministry of Health’s recommendations). Preliminary results, which still need to be reviewed, show that none of these treatments had a significant impact on mortality or length of hospital stay. Four drugs were tested on 11,266 adult patients in 500 hospitals in more than 30 countries.
The World Health Organization’s findings contradict another recent study conducted by the American biopharmaceutical company Gilead Sciences, which concluded that treatment with remdesivir reduced the recovery time from Covid-19 by five days compared to patients who received a placebo. Approximately 1000 patients participated in this study, but it was not completed. It also raises many questions since Gilead Sciences is the manufacturer of remdesivir. Remdesivir can not be bought in pharmacies, it is taken only under the supervision of a doctor.
However, there are many drugs based on interferon-alpha; drops recommended by the Ministry of Health can be bought at a price ranging from 100 to 400 rubles. Hydroxychloroquine can be bought in Russian pharmacies with a doctor’s prescription, and the average price for a pack of 60 tablets is 600 rubles.
“Remdesivir” is approved for use in the United States and Europe; it is administered only under the supervision of a physician. In May, the US Food and Drug Administration (FDA) approved the emergency use of remdesivir to treat coronavirus infections. The drug has also been approved for use in the United Kingdom and is approved in several other countries.
Hydroxychloroquine, which made headlines largely due to US President Donald Trump’s endorsement, ultimately proved ineffective in treating the coronavirus. Some studies have shown that use of the drug, which was originally developed to treat malaria, can reduce or even eliminate the risk of developing the disease when exposed to a carrier of the virus. However, other studies suggest that it does not help treat the infection – and sometimes makes it worse. A group of British researchers concluded that patients who received the drug spent more time in the hospital and were more likely to die or require mechanical ventilation than those who received standard treatment for the disease. In June, the WHO decided to suspend trials of hydroxychloroquine after concluding that its use did not reduce mortality in Covid-19 patients compared with standard treatment protocols.
In June, the World Health Organization announced the effectiveness of the drug dexamethasone, currently the only drug approved by the organization for Covid-19. It is only effective in treating severe forms of the disease when the patient is hospitalized and receiving oxygen or on artificial lung ventilation. The drug has anti-inflammatory and immunosuppressive effects. It is usually used in autoimmune, inflammatory, rheumatic diseases (rheumatoid arthritis, systemic lupus erythematosus, and others), as well as in asthma. This drug is able to cope with the “cytokine storm” – one of the main causes of rapid deterioration in patients with severe forms of Covid-19, when an aggressive immune response to the virus occurs. Immune cells attack lung tissue, leading to hypoxia (reduced oxygen levels in the blood) and other serious consequences. According to preliminary data from the World Health Organization, treatment with dexamethasone reduces mortality by about one-third in patients on mechanical ventilation and by one-fifth in patients on oxygen alone. These data were obtained by researchers at the University of Oxford. No serious side effects were observed in any of the 11.5 thousand patients who participated in the study, except for a temporary increase in blood sugar levels when the drug was used for short-term treatment (up to two weeks). It is unlikely to help those who can easily manage the disease at home: a study by Oxford scientists found that dexamethasone did not help patients with a mild course of the disease who did not need respiratory support.
The Department of Health’s recommendations include the antibiotic azithromycin, but antibiotics in general are not effective in treating coronavirus because they are only designed to treat bacterial infections and do not work against viruses. Doctors prescribe antibiotics only in cases of concurrent bacterial infection or confirmed pneumonia.