Expert: Effective COVID-19 therapies may be here by fall
Effective therapies for COVID-19 may become available in the next 3 to 4 months, with a vaccine possible next year, according to Kevin L. Winthrop, MD, MPH, of the Oregon Health & Science University.
Winthrop, who is also a Healio Rheumatology peer perspective board member, cautioned that even with effective treatment, it will be a long time before society in the United States returns to its pre-pandemic status quo. He added that current spikes in COVID-19 cases throughout the country are likely due to reopening too early and failing to take social distancing and mask guidelines seriously enough.
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“My future thoughts on COVID-19 are that we are going to muddle through this over the next 6 months,” Winthrop said, addressing attendees on a webcast at the GRAPPA Annual Meeting. “I think in 3 to 4 months we will have some effective therapies that will be able to take the pressure off society a bit, and allow a stop rate, perhaps, with a bit more freedom in terms of our physical relationships with others, and I think we will look for a vaccine for next year.
“However, I don’t think we will be able to go back to normal for some time,” he added. “I think, if you look at our curves, that the biggest difference between us and some of the other countries is we that reopened when our curve was at a plateau, while European countries saw a rapid increase and then didn’t reopen until they had a steep decline in cases. I really think we just opened too early. Not to mention, we just did not reopen right — not enough mask wearing, not enough social distancing.”
According to Winthrop, treatments currently being studied for COVID-19 include IL-6 inhibitors, such as tocilizumab (Actemra, Genentech) and sarilumab (Kevzara; Regeneron, Sanofi), which are both awaiting trial data review. JAK inhibitors, including baricitinib (Olumiant, Eli Lilly & Co.), and abatacept (Orencia, Bristol-Myers Squibb) are also undergoing trials.
Although concerns regarding steroids causing worse outcomes in COVID-19 are legitimate, Winthrop said, recent, yet-unpublished data suggests that 6 mg of dexamethasone once daily is associated with a lower mortality rate in a large number of patients.
“This hasn’t been published yet in peer-reviewed literature, so I am still reserving comment until I see the actual data,” he said. “I think one thing we’ve learned in the last few months is that there are lots of open-label reports and cases series, and they don’t necessarily translate into the same type of findings when put to a randomized controlled trial. So, I anxiously await that data.”
Regarding other possible treatments, Winthrop reported that he is the global principal investigator in a clinical trial of opaganib (Yeliva, RedHill Biopharma), a sphingosine kinase-2 selective inhibitor that has antiviral and anti-inflammatory properties.
He added that he has “high hopes” regarding monoclonal antibodies, which he said are aimed at certain aspects of the coronavirus “spike” protein.
“They should be neutralizing them, they should work,” he said. “But, like I said, we are studying them — we will see. I suspect we will have data in the next 2 months that will hopefully show we have some effective therapies for individuals.”
Until then, Winthrop stressed that the best-known way to curb the spread of COVID-19 is to encourage people to wear masks and social distance.
“I think it is pretty clear that masks help, and, if you look around the world, the countries that have had widespread mask use have had an easier job of controlling this pandemic,” he said. “So, put your mask on.”
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Winthrop K. COVID 19 from an infectious disease perspective. Presented at GRAPPA 2020 Annual Meeting; July 10-11, 2020; Virtual.
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