An experimental treatment, based on one of the most used drugs against AIDS for more than a decade, has been the option chosen by the doctors of the Virgen del Rocío Hospital in Seville to successfully treat the first case of infection recorded in Spain SARS-CoV-2 (and coronavirus) (Miguel Ángel Benítez, 62 years old). This is the application of lopinavir/ritonavir, also used to prevent HIV, along with interferon beta, a protein that helps cells not be infected, as confirmed by EL PAÍS health sources.
“It is an experimental treatment that has given good results against other viruses,” explains Albert Bosch, president of the Spanish Society of Virology. “One of its biggest advantages is that they are drugs approved and used in other indications, so there is no doubt about their safety,” he adds.
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One of these viruses is the one that causes Middle East respiratory syndrome (MERS). Although a recent communication published in the journal Nature recalled that “there are no approved treatments against MERS”, Saudi Arabia – the country most affected by the disease – is promoting clinical studies in humans. “The results are promising, but there is still not enough evidence for approval and they are in the experimental phase,” said the experts consulted.
Santiago Moreno, head of infectious diseases at the Ramón y Cajal hospital (Madrid) explains that “ the SARS-CoV-2 protease is very similar to that of HIV”. “This enzyme is essential for the virus to replicate. The combination of lopinavir and ritonavir inhibits and blocks HIV. The results that we know so far about its use against coronaviruses are encouraging, ”he says.
Interferon beta, the other drug used in Seville, has a different mechanism of action. It is one of the so-called signaling proteins that human cells naturally produce when they are infected by a virus. “The objective is to alert the other cells, which thus develop greater resistance to infection,” says Bosch. Some Wuhan hospitals have also used the treatment used in the Virgen del Rocío for coronavirus patients, according to several communications published in scientific journals, although again “the evidence on its effectiveness is scarce,” experts say.
The use of lopinavir/ritonavir together with interferon beta is one of the so-called “experimental compassionate” treatments approved by the Ministry of Health. They are therapies whose use can be requested when there are no available therapeutic alternatives, usually in serious or life-threatening diseases. Physicians who believe it may be useful for a patient should obtain written authorization to administer it, both from the patient and from the health authorities.
The good results obtained at the Virgen del Rocío hospital are notable for the novelty of Covid-19 and because it provides new clinical evidence. As in medicine, however, a single case does not mean that it can be used in other patients or that the outcome will be the same. That is the mission of clinical trials.