Race to find COVID-19 treatments accelerates

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Race to find COVID-19
treatments accelerates
WHO launches megatrial to test repurposed drugs
and experimental drug candidates
With cases of the new coronavirus
disease 2019 (COVID-19) climbing
steeply everywhere from Madrid
to Manhattan , overwhelming one
hospital after another and pushing
the global death toll past 17,000, the
sprint to find treatments has dramatically accelerated.
Drugs that stop the novel coronavirus,
severe acute respiratory syndrome
coronavirus 2 (SARS-CoV-2), could save the
lives of severely ill patients, protect health
care workers and others at high risk of infection,
and reduce the time patients spend in
hospital beds.
The World Health Organization (WHO)
last week announced a major study to compare
treatment strategies in a streamlined
clinical trial design that doctors around the
world can join. Other trials are also underway;
all told, at least 12 potential COVID-19
treatments are being tested, including drugs
already in use for HIV and malaria, experimental
compounds that work against an
array of viruses in animal experiments, and
antibody-rich plasma from people who have
recovered from COVID-19. More than one
strategy may prove its worth, and effective
treatments may work at different stages of
infection, says Thomas Gallagher, a coronavirus
researcher at Loyola University Chicago’s
Health Sciences Campus. “The big challenge
may be at the clinical end determining
when to use the drugs.”
Researchers want to avoid repeating the
mistakes of the 2014–16 West African Ebola
epidemic, in which willy-nilly experiments
proliferated but randomized clinical trials
were set up so late that many ended up not
recruiting enough patients. “The lesson is
you start trials now,” says Arthur Caplan, a
bioethicist at New York University’s Langone
Medical Center. “Make it a part of what you’re
doing so that you can move rapidly to have
the most efficacious interventions come to
the front.”
To that end, WHO on 20 March announced
the launch of SOLIDARITY, an unprecedented,
coordinated push to collect robust
scientific data rapidly during a pandemic.
The study, which could include many thousands
of patients in dozens of countries, has
emphasized simplicity so that even hospitals
overwhelmed by an onslaught of COVID-19
patients can participate. WHO’s website will
randomize patients to local standard care or
one of the four drug regimens, using only
ones available at the patient’s hospital. Physicians
will simply record the day the patient
left the hospital or died, the duration of the
hospital stay, and whether the patient required
oxygen or ventilation. “That’s all,” says
Ana Maria Henao Restrepo, a medical officer
at WHO’s Department of Immunization Vaccines
and Biologicals.
The design is not blinded: Patients will
know they received a drug candidate, and
that could cause a placebo effect, Henao
Restrepo concedes. But it is in the interest of
speed, she says. “We are doing this in record
time.” The agency hopes to start to enroll patients
this week.
Rather than taking years to develop and
test compounds from scratch, WHO and others
want to repurpose drugs that are already
approved for other diseases and have acceptable
safety profiles. They’re also looking at experimental
drugs that have performed well in
animal studies against the other two deadly
coronaviruses, which cause SARS and Middle
East respiratory syndrome (MERS). And they
are focusing on compounds plentiful enough
to treat a substantial number of patients.
For its study, WHO chose an experimental
antiviral called remdesivir; the malaria
medication chloroquine (or its chemical
cousin hydroxychloroquine); a combination
of the HIV drugs lopinavir and ritonavir;
and that combination plus interferon-beta,
an immune system messenger that can help
cripple viruses. The treatments would stop
the virus by different mechanisms, but each
has drawbacks.
Remdesivir, developed by Gilead Sciences
to combat Ebola and related viruses, shuts
down viral replication by inhibiting a key
viral enzyme, the RNA polymerase. It didn’t
help patients with Ebola in a test during the
2019 outbreak in the Democratic Republic of
the Congo. But in 2017, researchers showed
in test tube and animal studies that the drug
can inhibit the SARS and MERS viruses.

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