Three months after the new coronavirus pandemic, it’s still unclear which drugs can fight the viral disease and which can’t – despite public figures like President Donald Trump applauding the unproven promise of some drugs. With public health at stake, the scientific community is looking for answers faster than ever.
When the new coronavirus tore through China in January and February, researchers and doctors quickly launched dozens of clinical trials to test existing drugs against COVID-19, the disease caused by the new coronavirus. But the research done so far in China has not provided enough data for conclusive answers.
“We commend the researchers around the world who have come together to systematically evaluate experimental therapeutics,” said Tedros Adhanom, Director General of the World Health Organization (WHO), in a press conference. “Multiple small studies using different methodologies may not provide us with clear, strong evidence that we need to know which treatments can save lives.”
In their fight for ‘clear, strong evidence’, WHO is launching a multi-country clinical study to test four drug regimens as COIVD-19 therapies: an experimental antiviral called remdesivir, the antimalarial drug chloroquine (or the related hydroxychloroquine), a combination of two HIV medications and the same two HIV medications along with the anti-inflammatory interferon beta.
The trial will be flexible and may add or delete additional treatment methods or sites over time. In that way, it seems similar to the adaptive study that the National Institute of Allergy and Infectious Diseases began in the United States in February that initially intended to test remdesivir, but could extend to other drugs. The US is not currently involved in the WHO study.
Hundreds of other clinical studies are underway, and other groups are also continuing to test the drugs the WHO has selected – here’s an overview of some of the drugs researchers are focusing on.
Chloroquine and Hydroxychloroquine
Studies have shown that hydroxychloroquine and the related chloroquine can prevent the new coronavirus from becoming infected in cells in the laboratory, and anecdotal evidence suggests that it may help patients with COVID-19. Since the drug has been around for decades as an antimalarial treatment, scientists have experience with it.
“It’s a well-known drug,” said Caleb Skipper, a post-doctoral infectious disease at the University of Minnesota, who doing a smaller trial with the drug. “Small amounts of laboratory data from recent years show that this drug is effective against viruses.”
Skipper trial is to see if hydroxychloroquine can prevent people who are exposed to the virus from developing a serious illness. They are hoping to recruit health workers, who are at high risk of exposure to the virus, to participate in the trial.
# COVID19 Post-exposure prophylaxis with hydroxychloroquine enrolled 45 subjects from 19 states. If you know a healthcare provider or household contact who has been exposed in the past <= 3 days, email them to [email protected] for instructions.
– David Boulware (@boulware_dr) March 18, 2020
The goal, Skipper says, is to get the drug into people’s systems early. “Especially with viruses, the sooner you inhibit their ability to replicate, the better you get. If a drug starts working, it’s more likely to work early in the disease,” he says. caught and treated early, the virus will be much less replicated. ”
The existing evidence about hydroxychloroquine points in the right direction, Skipper says, but all research on the drug is still very early. “It is far from proven to be effective,” he says.
Despite the limited evidence available, public figures, including Elon Musk and Trump, are pushing the message that hydroxychloroquine and chloroquine are the solutions to the outbreaks. “I feel good about it. That’s all, it’s just a feeling, you know, smart guy. I feel good about it, ” Trump said at a news conference on Friday.
As a result of the hype, the demand for the drug has risen and manufacturers are increasing production. In Nigeria there are two people overdose of the medication after Trump said it could cure COVID-19. People who use it for other conditions, such as lupus, are struggling to access their usual supply.
To be clear, there is still no conclusive evidence that chloroquine will treat COVID-19. And treatments that seem promising based on anecdotal reports or “feelings” often don’t end, which scientists know well: the most clinical studies fail, and they see that amplified in the coronavirus treatment efforts.
In February, doctors in Thailand they said they saw their COVID-19 patients improve the combination of two HIV medicines, lopinavir ritonavir. The WHO is testing the drug combination in their study, along with anti-inflammatory interferon beta, which the body naturally produces to ward off viruses. The drug combination was used in patients during the SARS and MERS outbreaks and it seemed to help.
But a clinical trial of those two drugs only in China discovered that patients with COVID-19 who received the drugs did not improve faster than patients who did not.
The study, which appeared this week, targeting a group of 199 seriously ill patients, who May why the drug was ineffective – the patients were already too sick. But Timothy Sheahan, a coronavirus expert and assistant professor at the University of North Carolina’s Gillings School of Global Public Health, says he wasn’t surprised that the drug didn’t work. “We’ve been working on that specific drug cocktail,” he says. “The fact that it failed is completely consistent with everything we’ve done in the past.”
The antiviral remdesivir was first developed for the treatment of Ebola, but research later found that it can also block MERS and SARS in cells. Laboratory tests have shown that it can also inhibit the new coronavirus in cells.
There is also anecdotal evidence that remdesivir helps treat COVID-19 patients, but there is no guarantee that a clinical trial will show that it works better than a placebo. That’s why the data collected about the drug through the WHO trial, the U.S. adaptive trial, and the other studies are so important: Before giving en masse to sick people en masse, they need to make sure it actually works.
Although not part of the WHO process, Chinese officials also reported that the Japanese anti-flu drug was favipiravir, which was tested in clinical studies, was effective in the treatment of COVID-19 patients. Japan is study the drug more closelyalthough the data from those studies on the drug has not yet been published. Based on the drug’s antiviral activity in cells, Sheahan says it would surprise him if this drug were ultimately effective. It doesn’t work against MERS in cells, he says, and MERS is similar to the new coronavirus.
In addition, some pharmaceutical companies are trying to re-use anti-inflammatory drugs to try that calm pneumonia in people with severe cases of COIVD-19; others are identifying the protective antibodies that people develop after they are infected with the virus in an attempt to make treatment.
Clinical trials take time to collect the data correctly, so there is likely to be no concrete evidence until next month or later. Patients are already receiving these drugs through compassionate use programs, which allow doctors to order experimental drugs in certain cases, and under off-label use, with doctors prescribing drugs outside of what they are approved for. However, to ensure that the clinical trial process takes place in addition, before drawing conclusions about the best course of action, patients can be treated on the basis of evidence.
The large number of studies conducted around the world for each specific treatment approach gives researchers more data to work with and data from different groups of people. “The more populations you can show a particular intervention works or doesn’t work, the more valuable it is,” Skipper says. “The more data available, the better.”