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 Table of Contents  
COMMENTARY
Year : 2021  |  Volume : 23  |  Issue : 1  |  Page : 109-110

Infectious disease immunotherapies: An update, revisiting an age-old adage in times of COVID-19


1 Department of Internal Medicine, AFMC, Pune, Maharashtra, India
2 Department of Microbiology, AFMC, Pune, Maharashtra, India
3 Department of Internal Medicine, Army Hospital Research and Referral, New Delhi, India

Date of Submission24-May-2021
Date of Acceptance25-May-2021
Date of Web Publication06-Jul-2021

Correspondence Address:
Surg Capt Anuj Singhal
Professor, Department of Internal Medicine, Army Hospital Research and Referral, New Delhi
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/jmms.jmms_79_21

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How to cite this article:
Atal A T, Lall M, Singhal A. Infectious disease immunotherapies: An update, revisiting an age-old adage in times of COVID-19. J Mar Med Soc 2021;23:109-10

How to cite this URL:
Atal A T, Lall M, Singhal A. Infectious disease immunotherapies: An update, revisiting an age-old adage in times of COVID-19. J Mar Med Soc [serial online] 2021 [cited 2021 Jul 26];23:109-10. Available from: https://www.marinemedicalsociety.in/text.asp?2021/23/1/109/320711



Sir,

As you would be aware, the COVID-19 pandemic continues to present a global challenge. The dynamics of the present scenario has necessitated changes in protocols based on the outcomes of clinical trials and epidemiological surveys, and it is our responsibility to highlight additions to our submission titled “Infectious Disease Immunotherapies – An Update: Revisiting an Age-Old Adage in Times of COVID-19.” The therapies and the evidence so listed in the review were presented in the light of evidence available at that time. We would like to highlight some of these key practice changing updates and developments.

Lopinavir/ritonavir in the RECOVERY trial did not show benefit in COVID-19.[1] In October 2020, the World Health Organization (WHO)-SOLIDARITY trial group produced its interim report. They concluded that hydroxychloroquine, lopinavir, and interferon beta-1a (IFN β-1a) regimens appeared to have little or no effect in hospitalized COVID-19 patients, resulting in removal of these drugs from treatment guidelines promulgated by the WHO.[2]

Convalescent plasma therapy (CPT) continues to generate a lot of debate in the scientific community. The PLATINA trial, studying the effects of CPT in severe COVID-19 patients in the state of Maharashtra, India, was paused in December 2020 when interim analysis showed higher deaths in the CPT group.[3] The PLACID trial, a phase-II randomized controlled trial conducted by the Indian Council of Medical Research (ICMR), had earlier shown no reduction in 28-day mortality or progression to severe disease with CPT.[4] The measurement of neutralizing antibodies, however, had not been done. The RECOVERY trial conducted between May 28, 2020, and January 15, 2021, too, failed to demonstrate a statistically significant difference in 28-day mortality in patients on CPT.[5] Acting on increasingly negative reports on the therapeutic efficacy, the ICMR-National task force for COVID-19 dropped the use of CPT from the National Guidelines.

Monoclonal antibodies continue to generate interest. In May 2021, Roche received Emergency Use Authorization (EUA) from the Central Drugs Standard Control Organization for its antibody cocktail (casirivimab and imdevimab) in India, for treatment of mild-to-moderate COVID-19 in adults and pediatric patients.[6]

Therapy targeting IL-6 receptor, too, provided heartening news. A randomized trial of 4116 adult patients showed that tocilizumab reduced mortality compared to standard of care in hospitalized COVID-19 patients with hypoxia and systemic inflammation. In this RECOVERY trial, patients allocated to tocilizumab were more likely to be discharged from hospital within 28 days (57% vs. 50%; rate ratio 1·22; 1·12–1·33; P < 0·0001).[7]

In addition, in May 2021, based on the clinical improvement shown in phase-II and phase-III trials, the Drug Controller General India granted Zydus Cadila EUA to use its drug “Virafin” (pegylated interferon alpha-2b) for the treatment of moderate COVID-19 infection.[8] A higher proportion of patients administered with PegIFN were reverse transcription–polymerase chain reaction negative by day 7.

Practice changing guidelines keep emerging and it is anticipated that future therapeutic breakthroughs will provide us with a much-needed effective modality to reduce COVID-19-related hospitalization and deaths.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
RECOVERY Collaborative Group Statement from the Chief Investigators of the Randomised Evaluation of COVID-19 Therapy (RECOVERY) Trial on Lopinavir-Ritonavir: No Clinical Benefit from use of Lopinavir-Ritonavir in Hospitalised COVID-19 Patients Studied in RECOVERY; 2020. Available from: https://www.recoverytrial.net/files/lopinavir-ritonavir-recovery-statement-29062020_final.pdf. [Last accessed on 2021 May 20].  Back to cited text no. 1
    
2.
Pan H, Peto R, Henao-Restrepo AM, Peto R, Henao-Restrepo AM, Preziosi MP, et al. WHO solidarity trial consortium. Repurposed antiviral drugs for Covid-19 interim WHO solidarity trial results. N Engl J Med 2021;384:497-511.  Back to cited text no. 2
    
3.
Debroy S. Times of India, Jan 8, 2021. Maharashtra's Plasma Trial Stopped as Data Reveals Higher Mortalities. Available from: https://www.timesofindia.indiatimes.com/city/mumbai/maharashtras-plasma-trial-stopped-as-data-reveals-higher-mortalities/articleshow/80162802.cms. [Last accessed on 2021 May 23].  Back to cited text no. 3
    
4.
Agarwal A, Mukherjee A, Kumar G, Chatterjee P, Bhatnagar T, Malhotra P. Convalescent plasma in the management of moderate covid-19 in adults in India: Open label phase II multicentre randomised controlled trial (PLACID Trial). BMJ 2020;371:1-10.  Back to cited text no. 4
    
5.
RECOVERY Collaborative Group. Convalescent plasma in patients admitted to hospital with COVID-19 (RECOVERY): A randomised, controlled, open-label, platform trial. medRxiv 2021;2021:21249258.  Back to cited text no. 5
    
6.
Cipla. Roche Receives Emergency Use Authorisation in India for its Investigational Antibody Cocktail (Casirivimab and Imdevimab) Used in the Treatment of Covid-19. Press Release; 2021. Available from: https://www.cipla.com/press-releases-statements/roche-receives-EUA-India-investigational-antibody-cocktail- casirivimab -Imdevimab. [Last accessed on 2021 May 23].  Back to cited text no. 6
    
7.
RECOVERY Collaborative Group Tocilizumab in patients admitted to hospital with COVID-19 (RECOVERY): A randomised, controlled, open-label, platform trial. Lancet 2021;397:1637-45.  Back to cited text no. 7
    
8.
Zydus. Zydus Receives Emergency Use Approval from DCGI for the Use of Pegylated Interferon Alpha-2b, 'Virafin' in Treating Moderate COVID-19 Infection in Adults. Available from: https://www.zyduscadila.com/public/pdf/pressrelease/press_release_zydus_receives_emergency_approval_for_the_use_of_pegylated_interferon_alpha_2b. [Last accessed on 2021 May 23].  Back to cited text no. 8
    




 

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