Published on August 17, 2020
Are There Effective Treatments for COVID-19?
Hydroxychloroquine? BTK Inhibitors? Convalescent plasma? Zinc? Dr. Anthony Mato from Sloan Kettering, NYC, joins Patient Power Co-founder, Andrew Schorr to report on which of these headline making drugs and treatments show promise for treating COVID-19. They also discuss how some cancer drugs have anti-inflammatory properties and may benefit COVID-19 positive patients. Watch the full report.
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Transcript | COVID-19 Treatments in the News: What’s True?
Can BTK Inhibitors be used to treat COVID-19?
So Dr. Mato, what about BTK Inhibitors? Many people are on ibrutinib (Imbruvica) or acalabrutinib (Calquence), maybe even in a study zanubrutinib (Brukinsa), a “nib” like that, a BTK inhibitor. I know there are studies going on about whether they can help people when they're sick, but since so many CLL patients are on these drugs, they wonder whether they're protected or if they develop COVID-19, it won't be as bad. What do we know?
Great question. The rationale for why BTK inhibitors might help is that in addition to killing CLL, they also augment the immune system, and they affect something called macrophage polarization. So it can help to shift the immune system from one that's very pro-inflammatory to one that may be anti-inflammatory, and inflammation is ultimately what kills patients when they have an underlying infection in addition to secondary infections that could occur. So the hypothesis is that using a drug like ibrutinib or acala or zanubrutinib might protect you from some of that inflammation.
Our study looked at that question, but I want to overemphasize the fact that because there's no particular guidance as to what should be done, people were generally stopping their CLL therapy at the time of COVID diagnosis and hospitalization. So over 80% of patients stopped their BTK inhibitors. What we found in that particular group was that they didn't help or hurt patients. So there's no strong rationale to discontinue them at this point, but what I can tell you is whether or not, based on the data we have, whether they have a protective effect. It really takes a randomized study to help answer that question, and there are at least three that I know of going on in the country right now addressing that in cancer and non-cancer patients.
Possible Treatments for COVID-19
One other question just about what medicines people are taking. There's been a lot of discussion and still debate, even though the FDA has weighed in, about hydroxychloroquine (Plaquenil). Some of the people had that. Did it make a difference?
We had a large number of patients in this group who did have hydroxychloroquine, and we did not see any advantage.
And remdesivir (Veklury)? We've heard about that.
Smaller numbers, and it's not something we specifically tested just because the number was too small at this time. But certainly, the data are at least encouraging, and that drug is available through the FDA for this indication.
So, Doctor, people are writing in and saying, well, protective stuff, could I take hydroxychloroquine and it would protect me? Should I take zinc, an antibiotic? All these things. And obviously, you have many patients in your practice. You're the Director of the CLL program in a major center. What do you tell people?
Yeah, we do get those questions at times. We look very closely at the guidance from FDA and CDC, and there's really no evidence that taking hydroxychloroquine or any other supplements are protective from either acquiring COVID-19 infection or having a less severe case if you happen to be on them at the time of infection. So our general guidance is to not do that because any medicine you take, from something as simple as a Tylenol, can have potential consequences. Hydroxychloroquine does have potential cardiac issues, and so we're not recommending that.
Okay. And things like zinc, people think it's harmless. You take it-
I wouldn't stop it, but I also wouldn't say that there's any strong evidence that it helps.
Okay. We don't have data yet on people being administered convalescent plasma. I don't know if you have experience about that in New York, and I know that wasn't part of your study, but do you have thoughts? We have a question about this going forward, whether more experience with, A, remdesivir or, B, convalescent plasma could make a difference.
All I can say about convalescent plasma is that I have had some anecdotal cases where it seemed to be the only thing that helped patients. I've had one patient who was febrile for about six weeks, and literally within 24 hours of getting a dose, he got better.
I've heard of a few patients like that at other centers. I think that there's not a lot of harm to come from it, and certainly, I think it's worth further study. I'm looking forward to some larger case series and studies to publish some data on that. So, I'm pro-convalescent plasma in the appropriate setting where a patient is quite symptomatic and hospitalized. I don't think it has any value as a preventive strategy at this moment based on absence of data.
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