特効薬も重症化する患者さんの疫学データもワクチンも、医療ソリューションも不十分な状態ですが、対症療法（抗血栓・血管炎・IL-6)ができはじめたこと、なにより経済が極めて危険な状態となったこと、欧米がロックダウン解除の方向に動き出していることから日本でもその方向になるのかなあと、思い始めています。いや、ファバラビル（アビガン）・レムデシビルは本当に効くのか？？とかなり疑心暗鬼です。特に前者はDoseもかなり多く副作用も怖いです。
3月に少し話題になったイベルメクチン。自分の場合は体重75Kgなので疥癬の治療量だと15mg（5粒）だが12mg（4粒）でよさそうです。古い疥癬の治療薬なので一粒671円すなわち3000円弱。パチンコのパッキー1枚で3人が救われる薬価です。これもMade In Japanなのですね。アビガン、レムデシビルが話題になっていますが、正直「おおっ！すばらしい特効薬」というデータはまだありません。こちらにももう少し注目していこうと思います。
The FDA-approved drug ivermectin inhibits the replication of SARS-CoV-2 in vitro
Although several clinical trials are now underway to test possible therapies, the worldwide response to the COVID-19 outbreak has been largely limited to monitoring/containment. We report here that Ivermectin, an FDA-approved anti-parasitic previously shown to have broad-spectrum anti-viral activity in vitro, is an inhibitor of the causative virus (SARS-CoV-2), with a single addition to Vero-hSLAM cells 2 h post infection with SARS-CoV-2 able to effect ~5000-fold reduction in viral RNA at 48 h. Ivermectin therefore warrants further investigation for possible benefits in humans.
https://www.sciencedirect.com/science/article/pii/S0166354220302011?fbclid=IwAR3xCGsfnZOFSXzHWYnu2PrS-aGzl9HXIr9oCzVlpJORgiMlO5d424hE-o4
ついに臨床データもでてきました。疥癬の治療量よりも少ないDose(疥癬は200μg・Kg だが、こちらは150μg・Kg)でしっかり効いています。
Usefulness of Ivermectin in COVID-19 Illness
https://papers.ssrn.com/sol3/papers.cfm?abstract_id=3580524&fbclid=IwAR0R0ELpAYXgDtu0mJgEmgmcl0ckuNblHNutM409HlT9NkB93bX5emdj4os
Abstract
Importance: There is no established anti-viral therapy for treating COVID-19 illness.
Objective: To study the usefulness of Ivermectin, an antimicrobial therapy, in COVID-19 outcomes.
Design: An international, multicenter, observational propensity-score matched case-controlled study using prospectively collected data on patients diagnosed with COVID-19 between January 1, 2020 and March 31, 2020.
Setting: An international multi- institutional deidentified healthcare outcomes database.
Participants: Hospitalized patients diagnosed with COVID-19 determined by presence of a positive laboratory finding confirming SARS-CoV-2 infection.
Exposure: Ivermectin (150mcg/Kg) administered once compared with COVID-19 patients receiving medical therapy without ivermectin.
Main Outcome: The principal outcome was to assess the association of ivermectin administration with survival in COVID-19.
Results: The cohort (including 704 ivermectin treated and 704 controls) was derived from 169 hospitals across 3 continents with COVID-19 illness. The patients were matched for age, sex, race or ethnicity, comorbidities and a illness severity score (qSOFA). Of those requiring mechanical ventilation fewer patients died in the ivermectin group (7.3% versus 21.3%) and overall death rates were lower with ivermectin (1.4% versus 8.5%; HR 0.20 CI 95% 0.11-0.37, p<0.0001).
Conclusions and Relevance: The administration of ivermectin during COVID-19 illness in hospitalized patients is associated with a lower mortality and hospital length of stay. These findings require confirmation in randomized controlled trials.
そして、残念ながらレムデシビルは、こんなデータも。緑茶カテキンに大敗。
Identification of Dietary Molecules as Therapeutic Agents to Combat COVID-19 Using Molecular Docking Studies
Mohammad Faheem Khan, Mohsin Ali Khan, Zaw Ali Khan, Tanveer Ahamad, Waseem Ahmad Ansari
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Abstract
Recently, a new and fatal strain of coronavirus named as SARS-CoV-2 (Disease: COVID-19) appeared in Wuhan, China in December of 2019. Due to its fast growing human to human transmission and confirmed cases in nearly every country, it has been declared as pandemic by World Health Organisation (WHO) on 11 March 2020. Till now, there is no therapy such as vaccines and specific therapeutic agents available globally. Inspite of this, some protease inhibitors and antiviral agents namely lopinavir, ritonavir, remdisivir and chloroquine are under investigation and also implemented in several countries as therapeutic agents for the treatment of COVID-19. Seeing the health crisis across the world, it was our aim to find out a suitable drug candidate which could target SARS-CoV-2. For this purpose, molecular docking of 7 proteinsof SARS-CoV-2 was done with 18active constituents that have previously been reported to be antiviral or anti-SARS-CoV agents. The docking results of these 18 compounds were compared with 2 FDA approved drugs that have are currently being used in COVID 19, namely Remdesivir and Chloroquine. Our result revealed that among all, epigallocatechin gallate (EGCG), a major constituent of green tea, is the lead compound that could fit well into the binding sites of docked proteins of SARS-CoV-2. EGCG showed very strong molecular interactions with binding energies -9.30, -8.66, -8.38, -7.57, -7.26, -6.99 and -4.90 kcal/mole for6y2e, 6vw1, 6vww, 6lxt,6vsb, 6lu7 and 6lvnproteins of SARS-CoV-2, respectively.Therefore, EGCG as per our results, should be explored as a drug candidate for the treatment of COVID-19.
このTable３の威力に驚き。まあ、もちろん鰯の頭も信心からという言葉もありますが、ワクチンも特効薬も重症化する対象者の疫学もはっきりしない以上、すぐできて副作用がないことはやるべきだと思っています。
