Antiviral drug speeds recovery of COVID-19 patients — small Wuhan study

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According to a study, treatment with interferon (IFN)-α2b may significantly accelerate virus clearance and reduce levels of inflammatory proteins in COVID-19 patients. The research team found that treatment with this drug, which has been used clinically for many years, significantly reduced the duration of detectable virus in the upper respiratory tract, on average by about 7 days. It also reduced blood levels of interleukin(IL)-6 and C-reactive protein (CRP), two inflammatory proteins found in COVID-19 patients.

Dr Eleanor Fish says that the research team at the University Health Network considered IFN-α therapy for COVID-19 after they demonstrated interferon provided therapeutic benefit during the SARS outbreak of 2002 and 2003. “Rather than developing a virus-specific antiviral for each new virus outbreak, I would argue that we should consider interferons as the ‘first responders’ in terms of treatment,” says Fish.

“Interferons have been approved for clinical use for many years, so the strategy would be to ‘repurpose’ them for severe acute virus infections.”

Interferons are a group of signalling proteins released by the human body in response to all viruses. As Fish explains, they are a “first line of defence.” They target different stages of a virus’s life cycle, inhibiting them from multiplying. They also boost an immune response by activating different immune cells to clear an infection. Some viruses, however, can block this natural defence mechanism. “But it is possible to override this block. If a virus blocks interferon production, then treating with interferon can offset this.”

The researchers conducted this exploratory study on a group of 77 patients with COVID-19 in Wuhan, China. These patients were admitted to Union Hospital, Tongii Medical College, between 16 January and 20 February, 2020. They represented moderate cases of the disease as none of the patients required intensive care or prolonged oxygen supplementation or intubation.

Despite the study’s limitations of a small, non-randomised group of patients, the work provides several important and novel insights into COVID-19 disease, notably that treatment with IFN-α2b can accelerate viral clearance from the upper respiratory tract and also reduce circulating levels of inflammatory factors that are associated with severe COVID-19.

Fish says a randomised clinical trial is a crucial next step. According to her, a clinical trial with a larger group of infected patients who are randomized to treatment or placebo would further this research. In the meantime, the findings from this study are the first to suggest therapeutic efficacy of IFN-α2b as an available antiviral intervention for COVID-19, which may also benefit public health measures by shortening the duration of viral clearance and therefore slowing the tide of the pandemic.

Abstract
The global pandemic of COVID-19 cases caused by infection with SARS-CoV-2 is ongoing, with no approved antiviral intervention. We describe here the effects of treatment with interferon (IFN)-α2b in a cohort of confirmed COVID-19 cases in Wuhan, China. In this uncontrolled, exploratory study, 77 adults hospitalized with confirmed COVID-19 were treated with either nebulized IFN-α2b (5 mU b.i.d.), arbidol (200 mg t.i.d.) or a combination of IFN-α2b plus arbidol. Serial SARS-CoV-2 testing along with hematological measurements, including cell counts, blood biochemistry and serum cytokine levels, and temperature and blood oxygen saturation levels, were recorded for each patient during their hospital stay. Treatment with IFN-α2b with or without arbidol significantly reduced the duration of detectable virus in the upper respiratory tract and in parallel reduced duration of elevated blood levels for the inflammatory markers IL-6 and CRP.
These findings suggest that IFN-α2b should be further investigated as a therapy in COVID-19 cases.

Authors
Qiong Zhou, Virginia Chen, Casey P Shannon, Xiao-Shan Wei, Xuan Xiang, Xu Wang, Zi-Hao Wang, Scott J Tebbutt, Tobias R Kollmann, Eleanor N Fish

University Health Network material

Frontiers in Immunology abstract

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