Latest data on COVID-19's potential treatments, effects on drug abuse and mortality

A living systematic review from The BMJ was updated on Dec. 17 to include new data on a number of possible drug treatments. The review currently concludes that corticosteroids probably reduce mortality, mechanical ventilation, and ventilator-free days in patients with severe COVID-19, but whether remdesivir has any impact is uncertain. Hydroxychloroquine, lopinavir/ritonavir, and interferon-beta seem unlikely to have benefits. “The effects of most drug interventions are currently highly uncertain, and no definitive evidence exists that other interventions result in important benefits and harms for any outcomes,” the review said.

Support for using an antibody cocktail against COVID-19 was provided by a manufacturer-funded study in the New England Journal of Medicine on Dec. 17. The interim analysis of a trial of the REGN-COV2 antibody cocktail included 275 outpatients with COVID-19, randomized to placebo or a higher or lower dose of the drug. It found reduced viral load with the therapy compared to placebo, especially in patients whose immune response had not yet been initiated or who had a high viral load at baseline. The results suggest this intervention can be “an effective antiviral therapy, enhancing viral clearance and thus leading to improved outcomes, particularly in patients whose own immune response to the virus is slow to initiate,” the authors said. They noted that confirmation, including completion of their trial, is needed.

The effects of the pandemic on drug misuse were highlighted by a new CDC advisory and a study. The Dec. 17 Health Alert Network Advisory was issued to bring clinicians' and others' attention to recent substantial increases in drug overdose deaths across the country, accelerating in March to May of this year. The increase was primarily driven by a rapid rise in deaths involving synthetic opioids, likely illicitly manufactured fentanyl, but there were also significant increases in deaths involving psychostimulants, such as methamphetamine. The trend was most notable in the western U.S., the CDC said. The agency urged clinicians to talk to patients about the changes in the illicit drug supply and overdose risks and to prescribe naloxone to patients who are at risk, including those receiving high morphine milligram equivalents or opioids with benzodiazepines. Patients should also be counseled that multiple doses of naloxone may be needed for a single overdose event.

During the early months of the pandemic, medications for opioid use disorder (OUD) were still prescribed to those already taking them, but there was less initiation of therapy and urine testing, according to a research letter published by JAMA on Dec. 15. The analysis of commercial claims data found that among individuals already receiving OUD medication, a slightly higher percentage filled at least one prescription in March through May 2020 than 2019. However, rates of first prescriptions, related visits, and urine tests dropped.

Several recent studies tried to determine the effects of the pandemic on overall mortality. Two retrospective studies, one from The BMJ on Dec. 15 and one from The Lancet Respiratory Medicine on Dec. 17, compared COVID-19 to influenza to highlight the newer virus's more severe effects. An article published by Annals of Internal Medicine on Dec. 15 showed how population aging and growth statistics should be incorporated to improve the accuracy of COVID-19 mortality estimates. Finally, a research letter published by JAMA Internal Medicine on Dec. 21 estimated excess mortality in California during the pandemic.