A box of dexamethasone, UK.

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JUSTIN TALLIS / AFP

  • Against the coronavirus, drug treatments are also a hope.

    Since the start of the epidemic, no miracle treatment but research is progressing, between hopes and disappointments.

  • So far, only one family of drugs has proven effective in reducing Covid-19 mortality: corticosteroids.

  • In France, the government is investing in monoclonal antibodies.

    Clinical protocols should be developed in the coming days.

    And these are not the only promising avenues researchers are working on.

While the coronavirus pandemic is experiencing its third wave at the start of the year in Europe, research continues to find an effective drug to treat the sick.

So far, no miracle cure has emerged, but trials are continuing.

Sunday, Gabriel Attal said on BFMTV that France had invested in monoclonal antibodies, which are among the "promising" treatments.

"Clinical protocols will be developed to work on this track (...) from the next few days", confirmed the government spokesperson.

Since the start of the crisis, many drugs have been tested.

Overview of those who work, those who have disappointed, and those who are still waiting.

Treatments that work

Today, very few existing drugs have shown their effectiveness against Covid-19.

Among these few chosen, dexamethasone, which leads to a reduction in mortality in very severe cases.

A solution also recommended by the WHO, which however advises against giving these drugs at the beginning of the disease, because it lowers the immune system.

Beyond dexamethasone alone, work published on September 2 in the American medical journal

Jama

showed that other drugs in the same family, corticosteroids, made it possible to reduce mortality by 21% after 28 days in patients. suffering from severe Covid-19.

Medications that don't work (or don't work enough)

Remdesivir is the big disappointment of the last few months.

Supported by the United States, this antiviral treatment, initially developed against Ebola, was initially considered very promising.

But, on November 20, the WHO finally recommended not to administer it to hospitalized Covid-19 patients, because it does not prevent death or severe forms of the disease.

The European clinical trial Discovery announced at the end of January the cessation of tests on this antiviral, "for lack of evidence of its effectiveness".

On the other hand, a study published at the end of May in the American journal

New England Journal of Medicine

showed that it slightly reduced the recovery time of hospitalized Covid-19 patients (from 15 to 11 days on average).

Hydroxychloroquine, recommended by Didier Raoult and Donald Trump, made the headlines for several months, becoming a political and controversial subject.

However, the studies have decided: hydroxychloroquine does not reduce the mortality of Covid-19, according to the British clinical trial Recovery.

A large number of already existing antivirals are being tested.

There are around fifty in all, "including at least 40 against HIV," explains Etienne Decroly, research director at the CNRS.

“There is a clear lack of therapeutic molecules against viruses in general.

Medicines are being developed on the basis of new strategies but the time frame will be much longer.

"

Monoclonal antibodies and the development of new drugs… Sources of hope

We hear more and more about monoclonal antibodies: this treatment mimics the reaction of the immune system after contamination, by blocking the tip of the virus that allows it to attach to human cells and penetrate them.

It already exists in the treatment of bronchiolitis in newborns, for example.

This solution is injected into the patient “in the hospital, in a medical setting.

As part of Covid-19, it is administered to patients under oxygenation to prevent them from going into intensive care, ”explains Manuel Rosa-Calatrava, research director at Inserm and co-director of the VirPath laboratory within the center international research center in infectious disease in Lyon.

Germany will also become the first country in the European Union to use this experimental treatment administered to Donald Trump from next week.

“These are things that are quite expensive in terms of production.

Today I do not believe that therapies based on monoclonal antibodies are becoming mass therapies, ”notes Etienne Decroly.

As proof, the German government bought 200,000 doses of this treatment for 400 million euros, which represents… 2,000 euros per dose.

Discovery will continue to test this solution.

Another hope: Tocilizumab, an immunosuppressant, used against rheumatoid arthritis, which so far gives mixed results.

The researchers are also interested in the plasma (the liquid part of the blood) taken from recovered people, transferred to patients with Covid-19, who could benefit from their antibodies.

This solution is currently being tested as part of the Recovery trial.

Finally, there are drugs… under development.

These chemical molecules do not yet have a name and their development could take time.

“It generally takes around ten years to develop them”, indicates Etienne Decroly, who recalls that “research is not Twitter, it is a long time.

"

"Repositioned" molecules, antibodies or regulation of immunity ... If scientists put so much energy into looking for a drug solution, it is to complete their vaccine arsenal.

"All other treatments are very useful when a person does not respond to the vaccine, or when there is a refusal of vaccination," says Manuel Rosa-Calatrava.

“We must have complementary therapeutic solutions.

But, by definition, the cornerstone is vaccination.

“Nearly 1.5 million people were first vaccinated in France in January.

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