Passion for "Arbidol": consumer deception or virus fighter?

Author Irina Gusakova

05.04.2021 12:14

Health

Russian doctors recommend using Arbidol for the treatment and prevention of new coronavirus infection, since this drug has proven its effectiveness and safety. This is especially true for people who are contraindicated for vaccinations, as well as vaccinated people during the inter-vaccination period and after contact with COVID-19 patients.

Let us recall that in February 2021, the Ministry of Health of the Russian Federation included Arbidol in the tenth version of guidelines for the prevention, diagnosis and treatment of a new coronavirus infection.

The special path of Russian medicines

For several years now, Arbidol has remained one of the best-selling antiviral drugs in Russia.
It is even more popular than means to increase potency. If you believe the instructions for the medicine, in 2012 the citizens of our country bought 5 billion rubles worth of packages of it. Its active ingredient, umifenovir, was synthesized by Soviet pharmacologists from the All-Union Scientific Research Chemical and Pharmaceutical Institute named after. Sergo Ordzhonikidze (now JSC TsKhLS-VNIHFI in Moscow) and several other scientific institutes in 1974. They began selling it as a medicine in 1988. Despite such a venerable age of the drug, its effectiveness was tested only in the USSR and China.

Our country is different from others in many ways. Unfortunately, these meanings are not always positive. In the case of drugs, the fact is that we have little control over which drugs go onto the market. If in the USA the Food and Drug Administration carefully monitors what drugs enter the market, then in our country even experts cannot figure out what rules are used to register drugs. In Russia, unlike other countries, most medications are sold without a prescription. And there are a huge number of drugs whose effectiveness has not been really tested. These drugs include Arbidol.

According to modern rules of drug development, you first need to understand how a molecule of a potential active substance behaves “in a test tube”, with what it reacts and with what it does not. Then you need to test its effect on cell cultures. The next stage is animals. Typically mice and rats are used first, followed by non-human apes such as macaques. Animals are tested to see what maximum dose of a potential drug the body can tolerate, whether it is toxic in small doses, and what side effects it produces.

If a substance passes preclinical trials, clinical trials await it, this time on humans. Healthy volunteers use the potential drug for a period of time to further test it for possible side effects. In addition, the substance is given to hundreds of patients and they see how effectively it copes with the disease compared to a “dummy” placebo. If a potential drug turns out to be effective and safe enough for people, its developers can expect their brainchild to appear in pharmacies. And even after the start of sales of the drug, it continues to be tested in so-called post-marketing studies. People who have taken a new drug can report its effects, both good and bad, to the manufacturer.

In the case of Arbidol, everything happens, essentially, in the reverse order. Although it is the best-selling antiviral drug in the world's largest country, nothing concrete is known about the effectiveness of this drug. On the main page of the website dedicated to Arbidol, it is written in large letters: “The World Health Organization has included Arbidol in the list of drugs that have a direct antiviral effect.”

Under this inscription there is a link to the WHO website, where it supposedly says so. In fact, it turns out that the meaning of the WHO’s action was somewhat different. Umifenovir was assigned a separate code in the international drug classification ATX. This system exists to make it easier to collect information about the use of various drugs. Just because a substance has the code ATX does not mean it has been proven to be effective or safe. In essence, listing a drug in ATX is an acknowledgment that it exists and is used, nothing more.

Well, a search for articles on clinical trials of umifenovir in the largest database of scientific articles on medicine PubMed produces unintelligible results. In fact, in less than 30 years of sales of Arbidol, it was “checked for lice” only twice, and once in China. An article about this was published in Chinese. The second study is currently being conducted in Russia, and its final results are not yet known. About him - a little lower.

But in the last two years, several publications by foreign scientists have appeared, which finally reveal the potential mechanism of action of umifenovir. Generally speaking, it was necessary to start with such research, and not somewhere overseas, but here, because our compatriots developed this drug.

The use of a domestic antiviral drug from the perspective of evidence-based medicine

Perhaps none of the domestic drugs has recently been subjected to such targeted criticism, which appealed to the evidence base for its use in influenza. Many special medical problems began to be discussed in the media. Therefore, it seems advisable to professionally and impartially understand the essence of the problem.

First of all, it is necessary to recall the basics of general and clinical pharmacology, according to which a drug can influence the etiological, pathogenetic and symptomatic components of the disease. Therefore, it is advisable to consider the use of Arbidol for influenza from these positions, adding to them an analysis of the quality of previously conducted clinical studies from the standpoint of evidence-based medicine and an assessment of not only the effectiveness, but also the safety of the drug.

Impact on the etiology of the disease

The causative agent of influenza infection is the influenza virus, which is an enveloped RNA-containing virus with a negative genome. Inside the virion there are 8 RNA segments associated with proteins of the polymerase complex and the nucleocapsid protein. The inner side of the lipid membrane of the virus is lined by the main structural membrane protein M1, and the M2 protein that forms ion channels is immersed in it. Externally, two surface glycoproteins of the influenza virus are immersed in the lipid membrane of the virus - hemagglutinin (HA) and the viral enzyme neuraminidase (NA), which determine the extraordinary variability of the influenza virus [1].

In the reproductive cycle of the influenza virus, which lasts for 6–8 hours in the cells of the upper and lower respiratory tract, early and late stages are distinguished. In the early stages, adsorption of the virus on the cell surface and penetration of the virus into the cell occurs. After HA binds to cellular receptors, the virus enters endosomes, where the lipid membrane of the virus merges with the endosome membranes. In endosomes, a low pH value activates ion channels formed by the M2 protein, the operation of which leads to the release of the viral ribonucleoprotein from the M1 protein covering it, the release of the viral genome and the beginning of transcription. The later stages include primary and secondary transcription, translation and assembly of the virion on the cell surface, leading to the formation of mature viral particles and their further release from the cell.

At these stages of viral reproduction, an important role is played by the influenza virus enzyme neuraminidase, which cleaves the neuraminidase component of the sialic acid of the hemagglutinin receptors of the epithelial cells of the respiratory tract, helping to release newly formed viral particles from the cells and infect them with new cells [1]. According to experts from the Food and Drug Administration, USA, only drugs that have a direct direct effect on virus replication can be called antiviral, i.e., the action of these drugs is directed at a specific virus-specific target in the virus reproduction cycle [2, 3]. The target of action of adamantane-type anti-influenza drugs (amantadine and rimantadine) is the M2 protein of the influenza virus [4, 5]. The function of the viral enzyme neuraminidase is blocked by the anti-influenza drugs oseltamivir and zanamivir [1]. The virus-specific target of Arbidol's action in the viral reproduction cycle is the surface protein of the influenza virus NA.

Arbidol, interacting with NA, leads to a change in its spatial structure, resulting in the inability of the virus to penetrate into cells [6–7]. The most important indicator of the direct antiviral effect of a drug is its ability or the ability of its metabolites to suppress virus reproduction in cells, which is numerically expressed as an inhibitory concentration of 50 (IC50 is the concentration of a drug that inhibits virus replication by 50%). It is important to note that the effectiveness of a drug with detected antiviral activity in cell culture is manifested at the body level only if the order of concentrations that cause suppression of viruses in cell culture is achieved in human blood plasma or in places where the virus multiplies (for example, in the case of influenza infections in the cells of the respiratory tract, lung tissues, etc.) [2, 3]. Pharmacokinetic studies have shown that the concentrations of all recognized etiotropic anti-influenza drugs in the blood are comparable to their concentrations necessary to suppress viral reproduction in cell culture.

Analysis of the data presented in the table allows us to make an unambiguous conclusion that Arbidol meets all standard international requirements for antiviral drugs. It should be especially noted that these data were obtained in various domestic and foreign research centers.

The effect of Arbidol and other drugs for the treatment of influenza on the immune system

Arbidol has an immunomodulatory effect, leading to an increase in the total number of T-lymphocytes and T-helper cells. Normalization of these indicators was observed in patients with an initially reduced number of CD3 and CD4 cells, and in individuals with normal functioning of cellular immunity there were practically no changes in the number of T lymphocytes and T helper cells. At the same time, the use of Arbidol does not lead to a significant decrease in the absolute number of T-suppressor lymphocytes - thus, the stimulating activity of the drug is not associated with inhibition of the function of suppressor cells. In experiments in vitro and in vivo, Arbidol has an activating effect on the phagocytic function of peritoneal macrophages. Thus, the drug increases the phagocytic number (PF) by 123%, the phagocytic index (PI) by 221% and macrophage activity (MPA) by 176%.

This effect is one of the most important mechanisms of the body's defense against infection. It is assumed that the activating stimuli for phagocytic cells were cytokines and, in particular, interferon, the production of which is enhanced under the influence of the drug. The content of natural killer cells, NK cells, also increases, which allows the drug to be characterized as an inducer of natural killer cell activity. Thus, the presence of immunomodulatory activity in Arbidol in relation to various parts of the immune system prevents the occurrence of secondary infections and the development of exacerbations of chronic diseases in patients [60–63].

Oseltamivir and zanamivir do not have immunomodulatory properties. Oseltamivir does not affect the formation of anti-influenza antibodies, including the production of antibodies in response to the administration of an inactivated influenza vaccine. There is evidence that treatment with oseltamivir can significantly reduce the levels of interleukin 6 (IL-6) and TNF-alpha, markers of the inflammatory response to an infectious disease, compared to placebo [64–65].

Ingavirin has a modulating effect on the functional activity of the interferon system: it causes an increase in the interferon content in the blood to the physiological norm, stimulates and normalizes the reduced alpha-interferon-producing ability of blood leukocytes, stimulates the gamma-interferon-producing ability of leukocytes. Causes the generation of cytotoxic lymphocytes and increases the content of NK cells. The anti-inflammatory effect is due to the suppression of the production of key pro-inflammatory cytokines and a decrease in the activity of myeloperoxidase [56].

Impact on the risk of developing the disease and its complications, as well as its clinical symptoms

And

data are presented on the effect of Arbidol and other antiviral drugs on the risk of development and course of ARVI and influenza, as well as their complications in different age groups.

As can be seen from

and, Arbidol is not inferior in its preventive and therapeutic effectiveness to existing antiviral drugs, and often surpasses them.

Clinical studies on Arbidol from the perspective of evidence-based medicine

Currently, there are several levels of research evidence, which are designated by numbers (from 3 to 5–7), and the lower it is, the greater the reliability of the research data. The studies themselves can be divided into three categories according to the level of evidence (maximum category I):

Category I - this includes well-designed, large, randomized, controlled studies, meta-analysis or systematic reviews;
Category II - this includes cohort studies and case-control studies;
Category III - this includes uncontrolled studies and expert consensus.

Practical recommendations for diagnosis and treatment are based both on research results and on extrapolation of these data. Taking this into account, recommendations are divided into several levels, which are usually designated by Latin letters - A, B, C, D, E ().

Level A recommendations are based on the results of studies classified as category I evidence and, therefore, have the highest level of reliability. The reliability of level B recommendations is also quite high - when formulating them, materials from category II studies or extrapolations from studies of category I evidence are used. Level C recommendations are based on uncontrolled studies and expert consensus (category III evidence) or contain extrapolations from category I and II recommendations.

The quality of research publications themselves is currently recommended to be assessed using the Jadad questionnaire, in which the maximum score is 5 points.

It is obvious that for an antiviral drug used for influenza, it is necessary to distinguish two groups of clinical studies assessing its preventive and therapeutic effectiveness.

Research on the preventive effectiveness of Arbidol

Currently, there are 18 domestic publications on the preventive effectiveness of Arbidol during an influenza epidemic. We selected three official reports on clinical trials of the drug for analysis, since it was these studies that became the legal basis for the subsequent use and further study of the drug.

Clinical study of the preventive effectiveness of the anti-influenza drug Arbidol (Appendix 1). This study is described as a randomized study using identical placebo - +2 points on the Jadad questionnaire.
Study of the preventive effectiveness of Arbidol during the 1988 influenza epidemic (Appendix 2). This study is described as randomized, double-blind, using identical placebo and indicating the number of patient dropouts from the study groups - +4 points on the Jadad questionnaire.
Clinical trial in adults as a prophylactic anti-influenza drug of the new chemotherapy drug Arbidol (Appendix 3). This study is described as randomized (random number tables were used), double-blind, using identical placebo - +4 points on the Jadad questionnaire.

The results of assessing the quality of clinical studies conducted according to the most important formal criteria are presented. As can be seen from them, the number of points scored ranged from 64% to 78% of the maximum possible result (an average of 68%). According to the Jadad questionnaire, the average score of the analyzed studies was 3.3 points out of a maximum possible 5 points. Thus, the analysis allows us to make an unambiguous conclusion that, according to most of the evaluated criteria for a high-quality clinical study, work on the preventive activity of Arbidol is at a level significantly above average. It is noteworthy that 2 out of 3 studies on the Jadad questionnaire scored almost the maximum number of points.

The studies themselves on the preventive effectiveness of Arbidol belong to category I studies with a level not lower than 1b.

Research on the therapeutic effectiveness of Arbidol

Currently, there are 17 domestic and 3 foreign publications on the therapeutic effectiveness of Arbidol for ARVI and influenza. We selected 2 publications about a clinical trial of a drug for influenza for the study.

Efficacy and safety of using the drug Arbidol for influenza (Appendix 4). This study is described as randomized (random number tables were used), double-blind - +3 points on the Jadad questionnaire.
Multi-purpose, randomized, double-blind, parallel clinical trial of the therapeutic efficacy of the drug Arbidol (Appendix 5). This study is described as randomized (random number tables were used), double-blind - +3 points on the Jadad questionnaire.

The results of assessing the quality of clinical studies conducted according to the most important formal criteria are presented. As can be seen from them, the number of points scored ranged from 71% to 78% of the maximum possible result (an average of 5%). According to the Jadad questionnaire, the average score of the analyzed studies was 3 points out of a maximum possible 5 points. Thus, the analysis allows us to make an unambiguous conclusion that, according to most of the evaluated criteria for a high-quality clinical study, work on the therapeutic effectiveness of Arbidol is also at a level significantly above average.

The studies themselves on the therapeutic effectiveness of Arbidol belong to category I studies with a level not lower than 1b.

Safety of prevention and therapy with Arbidol

One of the most important criteria for the widespread use of a drug in the population is not only its preventive and therapeutic effectiveness, but also the safety of use.

To the studies analyzed above, it is necessary to add the results of two more double-blind studies of Arbidol performed in China (Appendix 4 and 5).

As can be seen from the presented data, Arbidol has a minimal number of side effects, which increases patient adherence to therapy, and makes it possible for doctors to prescribe the drug to the population.

The discussion of the results

The widespread use in Russia and inclusion in the list of vital drugs of the original domestic etiotropic antiviral drug Arbidol, intended for the treatment and prevention of influenza A and B, as well as other acute respiratory viral infections, is based on convincing data that meets the requirements of evidence-based medicine. The antiviral activity and mechanism of virus-specific action of Arbidol have been convincingly proven in numerous preclinical studies performed not only in leading scientific centers in Russia, but also in the USA, Great Britain, Australia, France, China and other countries. More than 12,400 and 1,400 individuals, respectively, participated in clinical studies on the preventive and therapeutic effectiveness of Arbidol.

An analysis of publications on the use of Arbidol allows us to conclude that the drug is currently well studied, has a reasonably high degree of evidence of use, and in the future there is no need to prove the previously proven high effectiveness and safety of use.

Literature

Laver WG, Bischofberger N., Webster RG Disarming Flu Viruses // Scientific American. 1999. V. 280. P. 78–87.
FDA. Antiviral Drug Advisory Committee. Gaithersburg: Center for Drug Evaluation and Research. 2002. P. 1–266.
Hayden F. WHO Guidelines on the Use of Vaccines and Antivirals during Influenza. Annex 5-Considerations for the Use of Antivirals during an Influenza pandemic, Geneva, 2–4 October, 2002.
Hay A. Amantadine and Rimantadine-Mechanisms. In book: Antiviral Drug Resistance, D. Richman (ed), John Willey and Sons Ltd, UK (1996), 44–58.
Belshe, Burk B., Newman F. et al. Drug resistance and mechanism of action amantadine on influenza A viruses // J. Inf. Dis. 1989. 159. 430–435.
Boriskin Y., Leneva I., Pecheur E. et al. Arbidol: a broad-spectrum antiviral compound that bloks viral fusion // Current Med. Chem. 2008. Vol. 15. P. 997–1005 (Review Invited, English).
Leneva IA, Russell RJ, Boriskin YS et al. Characteristics of arbidol-resistant mutants of influenza virus: implications for the mechanism of anti-influenza action of arbidol // Antiviral Res. 2009. Vol. 81. R. 132–140.
Leneva I. A., Fedyakina I. T., Guskova T. A., Glushkov R. G. Sensitivity of various strains of influenza virus to arbidol. Study of the effect of arbidol on the reproduction of influenza A virus in combination with various antiviral drugs // Therapeutic archive. 2005, No. 8.P.84–88
Fedyakina I. T., Leneva I. A., Yamnikova S. S. et al. Sensitivity of influenza A/H5 viruses isolated from wild birds in Russia to arbidol in MDCK cell culture // Questions of Virology. 2005. No. 6. P. 22–25
Burtseva E., Shevchenko E., Belyakova N. et al. Monitoring the sensitivity of epidemic strains of influenza viruses isolated in Russia to etiotropic drugs // Questions of Virology. 2009. 54 (5): 24–87.
Burtseva E. I., Shevchenko E. S., Leneva I. A. et al. Sensitivity to rimantadine and Arbidol of influenza viruses that caused epidemic increases in incidence in Russia in the 2004–2005 season // Questions of Virology. 2007. No. 2. pp. 24–29.
Lvov D.K., Burtseva E.I., Prilipov A.G. et al. Isolation on May 24, 2009 and depositing in the State Collection of Viruses (GKV N 2452 dated May 24, 2009) of the first strain A/Moscow/01/2009 (H1N1 ) swl, similar to swine virus A (H1 N1) from the first patient identified on May 21, 2009 in Moscow // Questions of Virology. 2009. T. 54, No. 6. P. 10–14.
Romanovskaya A. A., Durymanov A. M., Sharshov K. A. et al. Study of the sensitivity of influenza A (H1N1) viruses that caused illness in April-May 2009 to antiviral drugs in MDCK cell culture // Antibiotics and Chemotherapy . 2009. T. 54, No. 5–6. pp. 41–47.
Shi L., Xiong H., He J. et al. Antiviral activity of arbidol against influenza A virus, respiratory syncytial virus, rhinovirus, coxsackie virus and adenovirus in vitro and in vivo // Arch. Virol. 2007. Vol. 152. P. 1447.
Leneva I. A., Fedyakina I. T., Eropkin M. Yu., Gudova N. V., Romanovskaya A. A., Danilenko D. M., Vinogradova S. M., Lepeshkin A. Yu., Shestopalov A. M. Study of the antiviral activity of domestic anti-influenza chemotherapy drugs in cell culture and in animal models // Questions of Virology. 2010.

For the rest of the bibliography, please contact the editor.

V. I. Petrov *, Doctor of Medical Sciences, Professor, Academician of the Russian Academy of Medical Sciences S. V. Nedogoda *, Doctor of Medical Sciences, Professor I. A. Leneva **, Doctor of Biological Sciences

*Volgograd Medical University , Volgograd **TsKhLS VNIHFI , Moscow

Contact information for authors for correspondence

Appendix 4

Efficacy and safety of arbidol in the treatment of influenza

Wang MZ, Cai BQ, Li LY, Lin JT, Su N., Yu HX, Gao H., Zhao JZ, Liu L.

Efficacy and safety of arbidol in treatment of naturally acquired influenza.

Zhongguo Yi Xue Ke Xue Yuan Xue Bao. 2004 Jun; 26(3):289–293.

Objective: to evaluate the effectiveness and safety of arbidol hydrochloride in the treatment of influenza virus.

Methods: Conducting a double-blind, parallel clinical trial. Registration of participants.

Inclusion criteria: age - from 18 to 65 years, with flu symptoms, presented in the first 36 hours from the onset of the disease, with a temperature of 37.8 degrees or higher; epidemic rise in the incidence of influenza. The subjects were randomly divided into 2 groups, one group was prescribed Arbidol (200 mg 3 times a day for 5 days), the other group was prescribed placebo.

Results: The study included 232 subjects who were prescribed appropriate treatment and followed up. All subjects voluntarily took part in the drug study (113 people in the Arbidol group; 109 people in the placebo group). For various reasons, 22 subjects (9.3%) were unable to continue participation in the study. 210 subjects completed the study and were designated the RR group (102 people in the Arbidol group and 108 people in the placebo group).

Laboratory-confirmed influenza was present in 125 subjects who were assigned to the PPi group (59 people in the Arbidol group and 66 people in the placebo group). In the PPi group, general improvement in the condition of patients taking Arbidol occurred faster than in the placebo group. The average duration of illness in patients taking Arbidol was 72 hours (95% confidence interval 66.00–78.00 hours), and in the placebo group - 96 hours (95% confidence interval 87.46–104 ,54 hours). The average area under the curve of the severity of influenza symptoms versus the time of illness was significantly greater in the Arbidol group than in the placebo group. The mean area under the curve (symptom severity/time) was 780.00 and 684.00, respectively. Side effects were similar in both the Arbidol group and the placebo group. The main side effects are gastrointestinal upset and increased transaminases.

Conclusion: Arbidol is an effective and safe drug for the treatment of influenza at an early stage of the disease.

Appendix 5

Multicenter randomized, double-blind, parallel clinical trial of the therapeutic efficacy of arbidol hydrochloride tablets

LIU Hong-bo, QU Wen-xiu, LI Sheng-qi.

Multicenter randomized double blind parallel clinical trial of arbidol hydrochloride tablet.

The Chinese Journal of Clinical Pharmacology, 2006, 06.

Objective: to study the effectiveness and safety of arbidol hydrochloride tablets in the treatment of influenza.

methods : A double-blind parallel clinical study was conducted. The subjects were randomly divided into 2 groups: experimental (108 cases of disease) and control (105 cases), the patients of which took Arbidol or ribavirin tablets, 200 mg 3 times a day for 6 days.

Results : the clinical efficacy rate in the groups using Arbidol and ribovirin was 91.67% and 84.47%, respectively (PP analysis results, P > 0.05), and the recovery rate was 82.41% and 74.76% respectively. The percentage of adverse events was 7.62% and 5.71% in the experimental and control groups. The results of both groups were not significantly different (P > 0.05).

Conclusion: Arbidol is an effective and easily tolerated drug for the treatment of influenza at an early stage of the disease.

Lost Resolution

Not long ago, Russian-language media and social networks were making noise about the Memorandum on the pseudoscience of homeopathy, which was developed by the Commission for Combating Pseudoscience and Falsification of Scientific Research under the Presidium of the Russian Academy of Sciences. Its authors ask the Ministry of Health to “reconsider, in the light of current scientific data, decisions taken more than 20 years ago without sufficient grounds to introduce homeopathy into the Russian healthcare system” and “to withdraw homeopathic medicines from medical use in state and municipal medical institutions.” Facebook disputes revealed many hidden lovers of homeopathy and quarreled many good friends.

However, few people remember that ten years ago, in March 2007, a similar document was drawn up at the Academy of Medical Sciences (RAMS). The resolution of the meeting of the Presidium of the Formulary Committee of the Russian Academy of Medical Sciences dated March 16, 2007 stated: “The Formulary Committee of the Russian Academy of Medical Sciences, supporting the need for emergency measures taken by the Government of the Russian Federation to normalize the situation with drug supply to the population of the country, and realizing its involvement in the problem of drug supply, proposes:

Pharmacology

The instructions say that Arbidol belongs to the category of antiviral drugs. Once in the human body, it destroys influenza and coronavirus viruses.

The medication reduces the incidence of complications that can be caused by viruses, and also reduces the incidence of exacerbation of bacterial diseases that occur in a chronic form.

The use of the drug can reduce the duration of the disease. Intended for internal use and has virtually no toxic effects. If you adhere to the specified dosage, then no negative reactions will occur.

Once the active component enters the body, it is quickly absorbed from the digestive system. The maximum content is reached after 1.5 hours. Actively disperses throughout organs and tissues.

Metabolism occurs in the liver. The half-life is approximately 18-20 hours. About 45% of the constituent substances are excreted in their original form, most of them with bile, a small amount through the kidneys. In the first 24 hours, about 85% of the received dose of medication leaves the body.

Will the ARBITRATOR judge?

Let’s decipher what the words “multicenter, double-blind, placebo-controlled study” mean. By "multiple-double-blind study" it is assumed that no one knows who is being given the real drug - neither patients nor doctors. After all, otherwise everyone will think that the drug being studied will be more effective than the “dummy” drug, but in reality this does not always happen.

So, a clinical trial of the effectiveness of Arbidol with the ambiguous name ARBITR began in 2011. Information about it is even available in the American registry of clinical trials on the website clinicaltrials.gov. True, it has not been updated since 2013. There is more data on the Russian website of the register of medicines. It states that the ARBITRATOR is still ongoing and will only end on June 30, 2017. Accordingly, it will be necessary to wait about another year until the research results are processed and reports and scientific articles are published on them. Then it will be possible to understand whether Arbidol is as effective as the manufacturers write about it.

But, generally speaking, the preliminary results of the ARBITER are already known. They were published in 2015 in the journal Therapeutic Archives. In total, 293 patients with influenza managed to participate in it, but the data from clinical trials was not analyzed for all, but only for 119. Of these, only 45 were confirmed to be infected with the influenza virus by laboratory tests, and for the remaining 74, the conclusion was made based on symptoms. So in their case it might not have been the flu at all, but some abstract ARVI.

The results seem to be quite good: “60 hours after the start of therapy, resolution of all symptoms of laboratory-confirmed influenza was observed in 23.8 percent of patients receiving umifenovir therapy, which was 5.7 times higher than the same figure in the placebo group, which was 4.2% (p<0.05). A significant effect of umifenovir on the rate of elimination of the influenza virus was established, which, in particular, was manifested by a decrease in the number of patients in whom detection of viral RNA persisted for the fourth day or more (25% in the main group versus 53% of patients in the control group; p<0.05 )".

In general, if you take umifenovir, the time of illness seems to decrease. But these are only preliminary results; there should have been at least twice as many subjects. And professional doctors have questions about the research methodology. And the cherry on the cake: most of the authors of ARBITR are employees of companies that produce Arbidol and its analogues. And this gives reason to doubt his impartiality.

“Polyclinics are completely abandoning patients”

Siberian Ekaterina

At the end of June I received a positive PCR result for coronavirus. A therapist from clinic No. 7 came to her home and prescribed a number of medications:

- “Coronavir” - the therapist said that it seems like they should give it out, but the clinic doesn’t have it, so “buy it yourself,” the cost for a course of treatment is almost 12 thousand rubles. "Grippferon", the glucocorticosteroid "Metypred" and the blood-thinning drug "Xarelto". The last two drugs were brought from the clinic, but after I called the manager.

At the same time, she notes that her husband was also swabbed on the day when Catherine received a positive test, and, despite symptoms similar to coronavirus, they did not begin to treat him:

“Now I understand why there are so many seriously ill patients: we are being neglected at the primary care level, clinics are completely abandoning patients.

Then, 12 days after taking it, they found out that my husband’s smear was also positive, but he was not given free medicine.

“I called the deputy chief physician and asked if blood thinners were available, since they are also an integral part of our treatment. My husband and I drank Xarelto and finished “my” jar. The deputy said that these drugs were not available. I had to buy it myself, and the cost starts from 3,500 rubles. So only on TV and from the mouths of officials are outpatients provided with medications. In practice, everything is completely different, unfortunately.

Why take Arbidol

The main indication for use of the product is the treatment of viral diseases. Also used for preventive purposes.

The product is effective for the following diseases:

ARVI;
flu;
bronchitis and pneumonia (as part of complex therapy);
respiratory syndrome in severe acute form.

The product can also be used to prevent possible complications associated with the appearance and spread of infection after surgery, to stabilize the patient’s immunity.