TORONTO — Alongside the headline-grabbing race for a COVID-19 vaccine, the hunt for effective treatments has unfolded with its own share of flameouts and triumphs.
Thanks to large randomized trials in the United Kingdom and elsewhere, administering steroids to patients with moderate or severe illness has become part of standard care, but clinicians say few other tools have emerged.
The best known COVID-19 drug is likely dexamethasone, a corticosteroid with anti-inflammatory and immunosuppressant effects for hospitalized patients who need help breathing.
But while that drug is credited with helping efforts to bring down hospital mortality rates, credit also goes to discoveries about what does not work against the novel coronavirus – thereby ensuring people get appropriate care.
Here’s a look at some of the drugs – deemed effective and not – that made headlines in recent months for fostering hype and hope:
Remdesivir – Sold under the name Veklury, this Gilead Sciences drug was among various treatments given to former U.S. President Donald Trump when he successfully overcame COVID-19 last year. But its ability to cut deaths has since been largely discounted by a World Health Organization trial. An earlier study by Gilead found the drug helped moderately ill patients recover more quickly if given for five days, but that benefit was less clear if given over 10 days.
Health Canada noted clinical trial data was limited when it approved remdesivir for COVID-19 last July but said “given the high unmet medical need and emergency context of the COVID-19 pandemic, Health Canada considered the balance of benefit and harm for Veklury to be positive.”
Bamlanivimab – The federal government paid US$32.5 million for 26,000 doses of this monoclonal antibody that targets the spike protein of SARS-CoV-2. Eli Lilly says an intravenous infusion can ease and prevent COVID-19 symptoms among mild-to-moderate cases in high-risk groups including seniors.
Nevertheless, it has yet to be embraced by clinicians, with Hamilton infectious disease physician Zain Chagla calling it “a good example of a drug that might work on paper but really isn’t a great drug to invest in.”
The associate professor of medicine at McMaster University points to barriers to implementation, which include the staffing and time required to implement the transfusion.
Alberta Health Services says it’s considering a trial to determine “potential for benefit and feasibility of use” while British Columbia said Monday a clinical trial in Surrey would be funded by AbCellera, the Vancouver company which helped discover bamlanivimab.
CAUTIONS AGAINST EARLY HYPE
Hydroxychloroquine – Commonly used to treat lupus and rheumatoid arthritis, this drug earned infamy when U.S. President Donald Trump touted its efficacy with COVID-19 before the science was in. Since then, multiple rigorous trials have concluded it offers no benefit to preventing or treating illness while underscoring the dangers of mixing politics and science.
Colchicine – Just last week, the Quebec government cautioned clinicians against embracing this anti-inflammatory as a COVID-19 therapy after the Montreal Heart Institute touted the common gout medication as “a major scientific discovery.” Scientists at the National Institute for Excellence in Health and Social Services acknowledged the institute’s study showed positive results, but said the benefit was too small.
Tocilizumab – Dr. Niall Ferguson, head of critical care at the University Health Network and Sinai Health System, sees potential in early data for tocilizumab, approved for use in Canada to treat rheumatoid arthritis. Although evolving data has been mixed and is still emerging, Ferguson notes the monoclonal antibody is already being used off-label for some severe patients.
Heparin – Canadian scientists involved in a global trial for this blood thinner say interim data suggests it can keep some moderately ill COVID-19 patients from deteriorating further. University Health Network scientist Ewan Goligher says the probability of requiring life support dropped by about a third among subjects. He expects the study’s findings to be released soon.
Peginterferon-lambda – Research into this prospective antiviral treatment was recently published in Lancet Respiratory Medicine. Lead researcher Dr. Jordan Feld, a liver specialist at UHN’s Toronto Centre for Liver Disease, says a small Phase 2 trial found it significantly sped recovery for outpatients. Although more research is needed, he suspected it could offer an important way to quickly bring down the virus level in infected patients and reduce their risk of spreading disease to others.
Cassandra Szklarski, The Canadian Press