Given the rapid spread of COVID-19 and its relatively high mortality, filling the gap for coronavirus-specific drugs is urgent. It calls for repurposing existing drugs and developing trial plans to comprehensively test these drugs for use in COVID-19 patients much more quickly than researchers, ethics boards and regulators are accosted to, say R. Kiplin Guy and colleagues in this Perspective. They highlight several existing drugs that could be repurposed for COVID-19 patients that are being tested now.
The key issue with any of these potential treatments, say the authors, is to balance the needs of making treatment decisions for individual patients during epidemic peaks on the basis of clinical studies that involve small number of patients with ensuring that well-designed, randomized clinical trials are carried out rapidly. Controlled, randomized trials are needed to continue to test the efficacy and safety of drugs like hydroxychloroquine, azithromycin and remdesivir, they say. As COVID-19 is expected to be active in several seasons of disease peaks, the difficulty is to coordinate rapid studies during this first peak to justify a smaller number of well-controlled large trials to be executed in later peaks. Guy and colleagues note that researchers, ethics boards and regulators are accustomed to developing trial plans over months, not weeks--a time frame not afforded now. "It is necessary for all involved to work faster and more efficiently and then position the well-justified drugs for registrant-enabling trials during the next peak," they say.
Guy, R.K., et al. (2020) Rapid repurposing of drugs for COVID-19. Science. doi.org/10.1126/science.abb9332.