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Combinations of antivirals, anti-inflammatories and other drugs will likely be needed to treat people with coronavirus, a team of US Food and Drug Administration scientists said Friday.

It might even be necessary to customize treatment patient by patient, the FDA team said in a review of the treatments being tested against Covid-19.

“As the results of clinical trials become available, it may become increasingly clear that there is likely no single magic bullet to resolve the disease but a combination of several interventions that target different key factors of COVID-19 may well be required,” FDA drug researcher Montserrat Puig and colleagues wrote in a report published in Frontiers of Immunology. 

“Until vaccines and targeted drugs for COVID-19 are available, there may be a need to intervene with personalized therapeutic approaches. We are learning day after day, that patients may be affected by SARS-CoV-2 differently and that many factors influence the outcome of the disease.”

They reviewed 30 different drugs, including those designed to stop the virus from getting into cells, such as already-approved blood pressure drugs; drugs aimed at stopping the virus from replicating, such as the immune suppressors sirolimus and the antiparasitic drug ivermectin; drugs that control the immune system response, such as type 1 interferon; and drugs meant to block the overwrought inflammatory response to the virus, which include some rheumatoid arthritis drugs.

Different drugs could help people at different stages of the disease. Early on, it could be enough to stop the virus from getting into cells and replicating itself, Puig said. In patients with more severe disease, it will be more important to intervene in the body’s immune response to infection, which can include an overreaction known as the cytokine storm.

No drug is approved to specifically treat coronavirus infections, although the FDA has given emergency use authorization to the antiviral drug remdesivir. 

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