Arbidol The Russian Ministry of Health has excluded “Arbidol” (the trade name for the drug umifenovir) from the updated recommendations for the treatment of Covid-19 in high-risk patients with mild symptoms. Doctors and scientists have pointed out that the effectiveness of the drug has not been proven. “The drug umifenovir has been excluded from the treatment regimen for patients with risk factors and mild disease course in a hospital setting,” the department’s release said. According to new recommendations, these patients should be treated with virus-neutralizing antibodies or human immunoglobulin in a day hospital, if possible. Similar recommendations apply to pregnant women with mild Covid-19 symptoms.
However, “Arbidol” remains in the treatment protocols for Covid-19 in cases of mild illness in patients who are not at risk groups. The drug is approved for use in the treatment of children over 6 years of age. The Ministry of Health still recommends the use of “Arbidol” as one of the drugs for the pharmacological prevention of Covid-19. “Arbidol” is considered by the Ministry in its recommendations as a “broad-spectrum antiviral drug”. The authors of the recommendations advise its use in the early stages of the disease before a definitive diagnosis is made. This recommendation is based on the observation that the clinical presentations of mild COVID-19 and seasonal acute respiratory viral infections (ARVI) are very similar. At the same time, the Ministry of Health states that there is no evidence of the drug’s efficacy and safety. The lack of proven effectiveness is one of the main claims made by some doctors and scientists regarding the widespread use of “Arbidol” for the treatment of Covid-19.
We explain quickly, simply, and clearly what happened, why it matters, and what happens next. Episodes End of story Podcast advertising “Arbidol”, one of the best-selling cold medicines in Russia, was launched in the USSR in 1974. Before the Covid-19 pandemic, it was considered an antiviral agent and was widely used in the treatment of acute respiratory viral infections (ARVI) in children and adults. According to the drug’s instructions, “Arbidol” prevents the fusion of the viral lipid envelope and cell membranes and stimulates the activity of interferon. Arbidol is mentioned in the list of antiviral drugs for the treatment of influenza by the International Society for Influenza and other Viral Respiratory Infections (ISIRV-AVG). However, the document notes that its clinical efficacy in the treatment of influenza has not been established.
Scientists in China first discussed the possible effectiveness of “Arbidol” against the coronavirus in February 2020. Virologists at Zhejiang University then suggested that a combination of Arbidol and Darunavir, a drug used to treat HIV infection, might be effective against coronavir. As a result, on February 18 of last year, the National Health Commission of the People’s Republic of China, without waiting for the results of a large-scale trial, recommended the drug as one of the means to treat Covid-19. However, as early as April 2020, a group of Chinese experts refuted the effectiveness of using “Arbidol” against the coronavirus in combination with other drugs. The research was published in the journal Med. The publication states that randomized clinical trials have proven the ineffectiveness of using lopinavir along with ritonavir and arbidol to fight the coronavirus. According to Linhua Li, deputy director of the Center for Infectious Diseases at the Eighth People’s Hospital in Guangzhou, such a cocktail does not improve clinical outcomes, but can cause side effects.
In Russia, however, the publication of a study by Chinese scientists questioning the effectiveness of “Arbidol” against the corona virus did not affect the recommendations of the Ministry of Health. At the end of April last year, that is, two and a half weeks after the publication of the research results by Chinese scientists, “Arbidol” was included in the “Temporary Methodological Recommendations of the Ministry of Health for the Prevention, Diagnosis and Treatment of New Coronavirus Infection”. Then the Russian Ministry of Health recommended “Arbidol” in combination with nasal interferon-alpha as a possible treatment for mild forms of Covid-19. At the same time, the authors of the document noted that there is no evidence of the effectiveness of “Arbidol” and it is at the stage of clinical trials.
Russia has not always taken into account the results of researches of foreign scientists and decisions of international organizations when preparing recommendations for the treatment of Covid-19. In early May this year, the Russian Ministry of Health removed the antimalarial drug hydroxychloroquine from its recommendations, after the World Health Organization stopped testing it as an anti-coronavirus drug last summer. In June 2020, the WHO removed hydroxychloroquine from trials after experts found it could have dangerous side effects, including heart problems. At the end of May 2020, a study was published in The Lancet discussing the increased mortality rate in patients with Covid-19 who were taking hydroxychloroquine. The publication noted that it used data on the use of hydroxychloroquine in the treatment of Covid-19 patients in 10 countries. However, the Russian Ministry of Health at that time did not exclude hydroxychloroquine from the recommended drugs for the treatment of patients with Covid-19. The Ministry of Health referred to the results of several studies and “domestic experience”, which, according to the Ministry, indicated the possibility of effective use of the drug in low doses.
At the same time, the agency acknowledged that the mechanism of action of hydroxychloroquine is not fully understood and that the WHO has stopped testing it without proving the drug’s effectiveness. Sales of “Arbidol” in Russia began to grow at the end of January 2020, immediately after the appearance of rumors about its possible effectiveness against coronavirus infection. At the end of January 2020, some Russian mass media published an advertisement of “Arbidol” as a means against the coronavirus. Later, the Federal Antimonopoly Service (FAS) initiated a case on the appearance of this advertisement. According to DSM Group estimates, from the end of January to mid-February last year, sales of the drug in Russia increased by 18% compared to the same period in 2019. And when China added the drug to the list of drugs that can be used to treat Covid-19 in mid-February, the growth rate of “Arbidol” sales increased. According to DSM Group, last year the sales volume of “Arbidol” increased by 354% to 11.3 billion rubles. According to Forbes, in 2020, the companies “Otisipharm” and “Pharmstandard” of billionaire Viktor Khritonin earned the most in Russia in the pharmaceutical trade. Haritonina Company produces, among others, “Pentalgin” and “Arbidol”.