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Antiviral and Chloroquine/Hydroxychloroquine

for COVID-19: What should we know from the
newest evidence
Disampaikan dalam webinar PD HISFARSI Jatim, 1 Okt 2020
REMDESIVIR
FAVIRAPIR
LOPINAVIR-RITONAVIR
OSELTAMIVIR
CHLOROQUINE
HYDROXYCHLOROQUINE
REMDESIVIR
 REMDESIVIR
•Broad-spectrum antiviral originally developed to treat hepatitis C and was
then tested against Ebola;
•In vitro activity against SAR-CoV-2;
•Some evidence of efficacy against COVID-19 in humans;
•Available on a ‘compassionate use’ basis in many countries;
•First COVID-19 treatment to be made available for use in the UK outside a
clinical trial;
•In the EU, remdesivir is now licensed for the treatment of COVID-19 in adults
and adolescents with pneumonia requiring supplemental oxygen.
•Remdesivir was superior to placebo in shortening the time to recovery in
adults hospitalised with COVID-19
•Ongoing trials : WHO Solidarity termasuk di beberapa RS di Indonesia
FAVIPIRAVIR = AVIFAVIR= AVIGAN
Medication class: Antiviral agent
Manufacturer/Distributor: Fujifilm Toyama Chemical (as
Avigan) and Zhejiang Hisun Pharmaceutical
Approved Indication: Favilavir is approved in China and
Italy to treat COVID-19.
Avifavir, a generic form of Avigan, has been approved to
treat COVID-19 in Russia.
Rationale: Reports from officials in China have said
favilavir (formerly called fapilavir) is clinically effective
against COVID-19.
 FAVIPIRAVIR = AVIFAVIR= AVIGAN
Ongoing trials
•Phase III Clinical Study to Evaluate the Performance and Safety of
Favipiravir in COVID-19;
•Oral Favipiravir Compared to Placebo in Subjects with Mild COVID-19;
•A Randomized Controlled Trial for Favipiravir Tablets Combine with
Chloroquine Phosphate in the Treatment of Novel Coronavirus
Pneumonia (COVID-19);
•Favipiravir Combined with Tocilizumab in the Treatment of novel
coronavirus pneumonia (COVID-19) — a multicentre, randomised,
controlled trial;
•The Efficacy and Safety of Favipiravir for novel coronavirus–infected
pneumonia — a multicentre, randomised, open, positive, parallel-
controlled clinical stud
 Lopinavir-ritonavir
Medication class: HIV protease inhibitor
Approved US Indication: Lopinavir-ritonavir is indicated in
combination with other antiretrovirals to treat HIV-1
infection in adults and in pediatric patients 14 days and older.

Rationale: Lopinavir-ritonavir has been effective against

SARS, showing in vitro activity against the disease in a 2004
study. Countries hard hit by COVID-19, such as Italy, have
recommended the drug combination as a treatment for the
novel coronavirus.
 Lopinavir-ritonavir
The Pharmaceutical Journal15 SEP 2020By Julia Robinson

Ongoing trials
•REMAP-CAP;
•RECOVERY (recruitment to lopinavir/ritonavir arm
closed as of 29 June 2020);
•SOLIDARITY (recruitment to lopinavir/ritonavir arm
closed as of 4 July 2020);
•DISCOVERY;
•Lopinavir/ Ritonavir, Ribavirin and IFN-beta
Combination for nCoV Treatment.
 OSELTAMIVIR
Inhibits neuraminidase enzyme, khususnya utk Flu Babi
Oseltamivir did not inhibit the replication of SARSCoV-2 in
infected Vero E6 cells in vitro

Dosage of oseltamivir in the case series of 99 patients was 75 mg

orally every 12 hours.

No data to date support utreatment of COVID-19

Digunakan di Indonesia, Pakistan

Masih on going trial
 CHLOROQUINE DAN HYDROXYCHLOROQUINE

Manufacturers/Distributors: Plaquenil and Hyloquin

Approved US Indications: Hydroxychloroquine is indicated to treat acute attacks of
malaria
. It is also indicated to treat rheumatoid arthritis, systemic lupus erythematosus and
porphyria cutanea tarda.

Rationale: Both hydroxychloroquine and chloroquine have demonstrated in vitro and in

vivo activity against SARS-CoV-2. A 2005 study also showed chloroquine stopped SARS-
CoV from replicating in the laboratory.
 CHLOROQUINE DAN HYDROXYCHLOROQUINE

Regulatory actions: The FDA issued an EUA on 24 April allowing the use of
hydroxycholoroquine and chloroquine to treat adolescent and adult
inpatients with COVID-19

The FDA and EMA have repeatedly warned against using

hydroxychloroquine outside of hospital and clinical trial settings.
Status: Individual trials are in various stages of recruitment

Masih on going trial

Termasuk di Indonesia
Conclusions
Our study looks at three disease outcome measures of treatment with HCQ in
patients with COVID-19: mortality rates, progression rates, and severity rates. In
terms of mortality rates, it appears treatment with HCQ has a fatality rate that is
2.5 times greater than that of the control group.
Similarly, HCQ treated patients are more likely to have an adverse clinical
outcome and side effects.
Lastly, there was a 1.2-times higher rate of clinical improvement in the group of
HCQ treated patients, with mild to moderate symptoms as compared to the
control group.
EFEK SAMPING CHL DAN HCQ
 KESIMPULAN

• ANTIVIRAL UNTUK COVID MASIH ON GOING TRIAL

• CHLOROQUINE DAN HYDROXYCHLOROQUINE JUGA
ON GOING TRIAL
SEMUA OBAT MASIH KATAGORI OFF LABEL, KECUALI :
REMDESIVIR, VACCINE, TERAPI PLASMA KONVALESEN
Juga masih on going trial
PROTOKOL KESEHATAN