Should I run to the pharmacy?
About the drug "Coronavir"
Irina Yakutenko, Echo of Moscow
I can't help but write about the drug "Coronavir", which is planned to be sold in Russia for 12 thousand rubles (!) per package, and only three packages are recommended for the course (!!!). This is not a unique Russian development, but a long-known substance favipiravir, created in Japan for the treatment of high-lethal strains of influenza. However, its effectiveness could not be reliably confirmed – and in addition, in animal tests it turned out that favipiravir is a teratogen, that is, it causes deformities in the fetus when taken by pregnant women. Usually such a "find" is an unambiguous ban for "frivolous" drugs. For drugs, say, for cancer, this is acceptable, because the benefits outweigh the harm. Other well–known teratogens are tetracycline antibiotics, some antidepressants, anticonvulsants. It is important that all of them really help from the target disease, and their teratogenic effect is known, and these drugs are not prescribed to pregnant women. In the case of favipiravir, no significant effect has been proven for either influenza or coronavirus infection. Proponents of the use of favipiravir in COVID-19 insist that it inhibits the RNA-dependent RNA polymerase SARS-CoV-2. According to another hypothesis, it provokes the appearance of "serious" mutations in the RNA of the virus that kill the virus.
The success of the only completed clinical trials of the use of favipiravir in patients with coronavirus was announced in a press release from the company itself, no article was published. Yes, and such a success. Doubtful. Patients who took favipiravir were discharged from the hospital, on average, after 11.9 days, and those who received a placebo – after 14.7 days. And we have not yet seen the details of the experiment: how randomization, blinding, etc. was carried out. I remember that hydroxychloroquine also showed an effect in studies where these processes were carried out, let's say, very creatively. But it was worth doing everything wisely, as the effect mysteriously evaporated.
The Russian company that produces favipiravir also conducted tests and even published them in a magazine "Medical opponent". This is a Russian peer-reviewed publication founded in 2018. It is indicated that the journal is sent out "through a targeted free newsletter on databases of specialist doctors in Russia and neighboring countries, calculated for each issue of the journal on leading topics, as well as through professional specialized exhibitions, conferences and congresses, meetings of societies, schools and licensed cycles of advanced training of doctors." During the three years of the article's existence, it was quoted 61 times from there. That is, to put it mildly, this is not the top edition.
But, nevertheless, there is an article there – and this is certainly very good – and the results are comparable to the Japanese. Although the work has many nuances. First, the criterion of success was improvement of the condition, and not discharge, as in Japan. This is a very soft criterion. Secondly, there are very few participants, only 60 people, 20 of them in the comparison group. Randomization also raises questions: there were much more men in the comparison group, and the average age is higher – both of these factors increase the likelihood of a more severe course.
And most importantly, it is indicated that both groups, in addition to the main therapy (favipiravir in the experimental group or arbidol in the control group), received concomitant treatment, namely "antipyretics, antibiotics, anticoagulants (oral or parenteral) and symptomatic therapy." The key word here is anticoagulants. These drugs significantly reduce the risk of complications from COVID-19 (but by no means! never! they cannot be taken on their own! Because the side effect of these drugs is bleeding, including lethal) – and I would really like to see the dosages and so on of these drugs in both groups.
In simple terms: today we have every reason to believe that it is they, and not antiviral ones with unproven effectiveness, that determine recovery and patients with severe symptoms (there are more drugs for severe patients, but about them another time). Well, 36 thousand for the course is, of course, famously. Especially considering the teratogenicity and the fact that people with mild or moderate symptoms are offered to take the drug (there are studies only for them), the absolute majority of whom will recover anyway. God bless you.
About the author: Irina Yakutenko is a molecular biologist, scientific journalist, author of the telegram channel "Weak-willed Bricklayers".
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