WHO’s Solidarity and Oxford’s RECOVERY trials can give a clearer picture on some drugs that showed early promise.
A consensus is developing globally amongst experts that Covid-19 will be here for longer than earlier imagined. WHO chief Tedros Adhanom Ghebreyesus talked about how many countries are still in the early stages of the epidemic, while chief scientist Soumya Swaminathan has warned against ignoring the possibility that the virus could become endemic. There are now reports of a second wave in China, with the country going for another round of lockdown. This underscores the urgent need to have a pharmacological intervention. While there was talk of an early breakthrough with existing drugs (against other conditions/pathogens) working against SARS-CoV-2, expectations are now tempered with conflicting findings in the therapeutics landscape and success unlikely before late first quarter of 2021 in the vaccine space.
The initial euphoria around chloroquine/hydroxychloroquine (HCQ)—the US president Donald Trump even called HCQ a “game-changer”—has worn off to a great extent, with trials showing no efficacy against Covid-19, or even adverse effect. While an early Chinese clinical trial talked about HCQ relieving Covid-19 symptoms faster in patients as compared to standard care, an American study reported increased mortality among patients administered treatment involving HCQ over those that received standard care. Hopes were similarly pinned on remdesivir, from Gilead Sciences, after leaked data of a University of Chicago trial showed early encouraging results.
But, there were gaps in the sample selection, and soon after, findings from an aborted study in China showed remdesivir was having no effect. While Gilead has questioned the credibility of interpretations from an abandoned study, a fuller picture will perhaps emerge when the US National Institute of Allergy and Infectious Diseases (NIAID) reports its findings from a trial with a robust methodology. The lopinavir-ritonavir combination that had been touted early on to have anti-Covid-19 action, too, has not been able to demonstrate incontrovertible efficacy. On the vaccine front, seven vaccine candidates reaching the clinical trial stage, as per WHO data, within three months of the pandemic is a record of sorts, but a successful vaccine is still quite some distance away. While the earliest one to go into trial, the Moderna-NIAID one, completes the full duration of its trial sometime in the second quarter next year, Serum Institute of India, which has developed a candidate in partnership with the University of Oxford, says that it can make the vaccine available in October this year, if the vaccine passes the clinical trial.
Meanwhile, authorities and experts are batting for treatment protocols that show any sign of promise, whether in limited trials or on paper. For instance, Dr Robert Gallo, the co-discoverer of HIV, has strongly batted for the oral polio vaccine, which has been documented to induce an innate immunity response against a host of pathogens other than the poliovirus. In the same vein, many jurisdictions are clearing plasma therapy—that involves the use of antibodies against SARS-CoV-2 from patients who have recovered. While this is being used in cases showing severe symptoms, given there have been reports of reinfection, it is not clear if this is a temporary cure or a disease management tool. Although the uncertainty is daunting, with the WHO’s Solidarity trial involving remdesivir, lopinavir-ritonavir, interferon alfa 2B (which has been reported to have some efficacy in patients in China) and chloroquine/HCQ, and the University of Oxford’s RECOVERY trial, involving lopinavir-ritonavir, HCQ, low dose dexamethasone (helps regulate inflammatory response like cytokine storms), azithromycin and to cilizumab, hope of greater clarity on a therapeutic line of intervention will also likely get clearer.