In the intensive care unit of Purpan hospital during the coronavirus crisis.

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FRED SCHEIBER / SIPA

  • The Toulouse University Hospital is participating in three trials to try to find an effective treatment against SARS-Cov2.

  • In this context, patients are treated with Remdesivir, but also plasma from convalescent patients and an antiviral on the test bench, Manulpinavir.

  • While the hydroxychloroquine trail has been abandoned since the spring by the CHU teams, the latter commonly use dexamethasone, cortisone, but also high flow oxygen, two “weapons” which have made it possible to avoid a number of patients going to intensive care.

The announcement of the arrival of several vaccines against SARS-Cov2 would almost make some forget that there is another avenue on which research is still looking: to find an effective treatment against this coronavirus.

In Toulouse, doctors have given up on hydroxychloroquine since the spring, which has caused so much debate.

Time used in the framework of the international clinical trial Discovery, in which the University Hospital of the Pink City is participating, "we have interrupted it," explains Professor Pierre Delobel, head of the infectious and tropical diseases department.

Hydroxychloroquine, Remdesivir ... Little or no benefits

“Unambiguously, the results show that there were no beneficial effects.

It's crisp and clear.

The scientific debate is over: it does not work.

We have even had patients who took it who had significant cardiac arrhythmias, ”explains the doctor, whose teams have not used the molecule so much defended by Didier Raoult since the spring.

Lopinavir, known to treat HIV, has also been released from drugs used to treat patients.

On the other hand, Toulouse doctors continue to administer remdesivir to volunteer patients, an intravenous antiviral which should prevent or reduce viral replication in infected cells.

A prescription made as part of the Discovery trial only.

Because today, the drug from the Gilead laboratory, originally developed to treat Ebola virus disease, is widely criticized.

“For the moment, the studies are rather negative, apart from an American study which shows a beneficial effect on a subgroup of patients, on oxygen but not serious.

To decide and conclude on that, we need to continue to have a large-scale study and provide an answer, ”explains the person in charge of infectious diseases.

A total of 34 patients joined the trial cohort out of 1,224 internationally, including 25 since this summer.

Antiviral and plasma, more promising

Professor Delobel has more hopes in other trials launched recently and in which the Toulouse University Hospital is participating around plasma and an antiviral.

The first, initiated by the AP-HP, started in November and consists of transfusing convalescent plasma just once to around a hundred patients infected with Covid, including two already in Toulouse.

"The donors were chosen because they had a very high level of neutralizing antibodies in the blood, these convalescents had a very good immune response", explains Pierre Delobel.

A treatment that the Toulouse University Hospital had already used outside of a clinical trial, on an ad hoc basis, on patients who had an immune deficiency, who were not able to produce antibodies spontaneously.

For these patients, who often had a serious form, "one had the impression that it worked", estimates the practitioner, without drawing however anticipating a conclusion.

The CHU is also betting on MK 4482. Behind this code name is manulpinavir, an antiviral developed by the German laboratory Merck and which is administered in the form of tablets to be taken for five days in the morning and evening.

“It's a drug that inhibits an enzyme in the virus that helps it multiply.

We are sorely lacking antivirals, ”laments Professor Delobel.

The studies start with a search for effective doses, before verifying thousands of patients.

It is carried out with patients hospitalized but not having a serious form or patients who tested positive during their drive-test and who have risk factors.

Oxygen therapy and cortisone validated

While waiting to have conclusions on these future treatments, the intensive care teams and the infectious diseases department of the CHU are using those which have been proven since the first wave.

“What works is cortisone, dexamethasone, when given at the right time in the right patients with an inflammatory marker, it is clearly a beneficial treatment.

It is the major weapon of the current care ”, slices the head of department, who prescribes it to all the patients who worsen with an inflammatory profile at D + 8 or D + 10.

This treatment has made it possible for many patients to avoid going to intensive care.

Like high flow oxygen, “a therapeutic breakthrough that prevents intubation.

It does not work for everyone, but it makes it possible to pass the course ”, concludes Pierre Delobel who hopes that an effective antiviral will be found.

If the vaccine track is promising, we do not know when it will be deployed on a large scale, we do not yet know the duration of its protection, not to mention a possible mutation of the virus itself.

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