No drug arouses as much emotion in the medical community in Poland as amantadine. For several decades it was used in the treatment of influenza A, then Parkinson’s disease, and recently it has a new indication. Practitioners' observations suggest that it stimulates the nervous system, has an anti-inflammatory effect and may protect against the development of pocovid sequelae. Recently conducted clinical studies, initiated by Prof. Konrad Rejdak, are to verify these hypotheses. Last year, the head of the Department of Neurology at the Medical University of Lublin and President-elect of the Polish Neurological Society was the first in the world to publish the conclusions of a study verifying the effect of amantadine on the course of COVID-19.
– Your observations were recognised by scientists abroad much earlier than in Poland. What was the reason for this initial lack of favour of the national medical council to start clinical trials?
– The experimental treatment of COVID-19 patients with amantadine may have raised objections because it is not strictly an antiviral drug. It has other indications. It is used to treat neurological conditions such as Parkinson’s disease and multiple sclerosis. It has an anti-inflammatory effect, but above all it stimulates neurotransmitter systems in the brain. The use of amantadine in covid disease may have seemed risky to parts of the medical community. Caution in medicine is not a vice. From my observations of Parkinson’s disease and MS patients infected with coronavirus, it was clear that amantadine was helping them. These were people of all ages and health statuses who had very mild COVID-19, so I saw the need for clinical trials with this drug to see if it would be effective against the infection.
– There have been similar situations in the past, discouraging your professor from conducting clinical trials among other drugs?
– There have been such situations. This is quite a natural reaction for us to something new. Every now and then in my practice I experience this. There are accusations that since no one in the West has conducted such studies so far, why do we want to do it in Poland.
– What do you reply then?
– I present arguments to justify my efforts and convince the sceptics. I am a neuropharmacologist by training, so clinical trials are part of my scientific activity. It was the same with amantadine. When the pandemic broke out, the world searched for different ways to fight the virus among registered drugs that had different therapeutic indications. More or less successful experiments were conducted everywhere. As a neurologist, I made observations of coronavirus-infected Parkinson’s and MS patients. I noticed that none of the dozen or so people taking amantadine passed the infection severely. And these people were also burdened with comorbidities. In such cases, patients go through COVID-19 much more severely, and in this situation it was different. I did not fail to describe this in a prestigious scientific journal.
– What was the reaction of the medical community to this report?
It was the first clinical report of its kind in the world on neurological patients taking amantadine in the context of COVID-19, developed with the participation of Professor Paul Grieb of the Institute of Experimental and Clinical Medicine of the Polish Academy of Sciences. This opened a wide discussion nationally and internationally. There were comments in other journals that amantadine might be an interesting option in the treatment of COVID-19. In parallel, similar concepts were born by various experts and this theory gained more and more supporters among researchers and doctors both in Poland and abroad.
– Who has taken an interest in your research abroad?
– To date, our work has been cited 47 times by, among others, centres from the United States, the United Kingdom, Germany, Spain, Mexico and recently also from China. Researchers have largely confirmed these results. A group from the University of Cambridge where they studied the survival of Parkinson’s patients on COVID-19 confirmed that none of those who received amantadine died. So we do not always have to wait for the world to come up with something, but we ourselves can successfully initiate it and be pioneers in certain solutions. Thanks to money from the Medical Research Agency, we have the opportunity to see if amantadine will be given an indication for the treatment of COVID-19. Until there is a cure for this disease, we will not be free of this pandemic.
– Professor, how does amantadine work?
– The drug is absorbed into the central nervous system and stimulates the relay systems in the brain. It supports the nervous system in fighting infection. Dopamine is an important transmitter that gives us motor drive. It is such a booster of body function in a critical condition. Patients who are fighting infection need this boost because they may have poor respiratory function.
– Some compare that amantadine acts on the brain like a turbo stimulator
– This is an exaggeration, but the drug stimulates breathing and can help the body fight infection effectively. If we stimulate the nervous system and thus the whole body, because all organs respond to nerve stimuli, we have a chance of breaking this covid crisis. We are still looking for evidence, testing whether amantadine can act on inflammatory changes in the lungs. Chinese studies seem to support this anti-inflammatory concept, regarding the inhibition of the immune response in this aspect. However, all this needs to be robustly investigated and this is what we are focusing on. However, until everything is verified in clinical trials, I recommend caution in the use of amantadine, especially for people who take it without consulting their doctor. You cannot make such decisions on your own, as this can have disastrous consequences for the body.
– When will the first clinical trial results be available?
– This is difficult to determine at this time. Clinical trials are being conducted in 8 nationwide centres to test the usefulness of amantadine in the treatment of covidien disease. These are university, provincial and district hospitals. A very important centre for us is the Central Clinical Hospital of the Ministry of Internal Affairs and Administration (MSWiA) in Warsaw, as well as the Independent Public Health Care Centres in Grudziądz and Wyszków, the Provincial Clinical Hospital in Rzeszów and the University Clinical Centre of the Medical University of Warsaw. We wanted to include in this study a wide range of patients more or less evenly across the country affected by covidien disease. We want to observe about 200 patients undergoing standard care who have the option of receiving treatment in coded form, i.e. active drug or placebo. In the early stages of infection, there are not many options except for close monitoring of the condition and administration of symptomatic drugs. We have some problem with recruiting people to the study. There are patients in very serious condition in hospitals, and we are focusing our research on patients with newly detected infection, because this is who our project is aimed at. We started at the end of March, so it is too early to draw any conclusions. We will certainly share the results of this research with the world.
Professor Konrad Rejdak was interviewed by Jolanta Czudak