While the scientific community seeks an effective treatment for tens of thousands of sick patients because of the new respiratory virus, surprising remedies are tested: medicines that fight killers known as HIV, Ebola and malaria.
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US pharmacists have sent two antiviral drugs to China, where doctors and public health officials seek effective treatment for patients with the new coronavirus, recently called Covid-19. The virus has affected tens of thousands of people worldwide and has claimed 2,118 lives, as of Friday. The majority of cases and deaths occurred in Hubei province, in China, where the outbreak began.
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Among the possible remedies is a HIV medication It could block an enzyme that the virus needs to mature. An unapproved medication that is used to fight the Ebola virus It is being tested in Chinese patients to see if it can alter the genetic material of the new virus.
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A third medication, used worldwide to fight the parasite that causes malaria, It is also tested in China to see if it can stop the infection by preventing the virus from infiltrating the cells.
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The researchers recognize that the scientific evidence to use these medicines are weak. But even with solid data, they say, human trials are the only way to know if these medications will be effective.
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“Just because it works well in a test tube and in animals does not mean that it works in people,” said Dr. Stanley Perlman, professor of microbiology and immunology at the University of Iowa.
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This initiative is not extraordinary. When a new virus emerges and endangers a large number of people, Scientists sometimes turn to existing medications that can be retrofitted. The medicines available in the United States have already undergone rigorous tests to prove that they are safe, thus avoiding the need for expensive human tests to assess their safety in an emergency.
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Generally, scientific evidence on medications and the virus is observed to try to find a viable option.
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“Typically, a fairly broad network is created because it is not known what will work for a particular virus,” said Dr. Rajesh Gandhi, a professor of medicine at Harvard University and elected president of the HIV Medicine Association.
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Drug fan
In 2003, a coronavirus related to the current one, without known treatment, caused a global outbreak of severe acute respiratory syndrome (SARS). The answer consisted of the trial of a range of drugs, including a combination of ritonavir and lopinavir, antiretroviral drugs used to fight HIV.
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Early studies indicated that medications were effective in fighting the virus in patients. The combination of medications, known by the trade name of Kaletra, seems to work to prevent the enzyme called protease from allowing the virus to mature and replicate. But the outbreak, and the ability to try robust treatments, disappeared in little more than a year.
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Nine years later, another coronavirus caused the Middle East respiratory syndrome (MERS). That outbreak gave scientists another chance to test HIV medication for this family of viruses, and clinical trials have begun in Saudi Arabia.
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Now Chinese doctors use Kaletra against the new coronavirus.
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Although it has been possible to test the HIV drug to fight pathogens related to the cause of the current outbreak, “everyone agrees that we don’t have a standard therapy for the new coronavirus“Gandhi said.
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Chloroquine against malaria
One of the least orthodox remedies that are being tested against coronavirus in China is the Chloroquine
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It is a medicine against malaria, a disease caused by a parasite that is transmitted by the bite of a mosquito. A limited number of studies have found that the drug works against SARS. A study published this year in Cell Research found that the drug was effective in laboratory tests to prevent the virus from spreading by stopping its method of cell infection.
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The lack of certainty about the treatment of coronaviruses is due, in part, to the way outbreaks arise and disappear: they can spread like a forest fire and then disappear, as did the SARS, Gandhi said. Although this is good for public health, it also means that scientists miss the opportunity to thoroughly test a treatment that fights the specific virus in humans.
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Dr. Anne Schuchat, deputy director of the Centers for Disease Control and Prevention (CDC), said at a press conference on February 11, that research on the virus that causes the outbreak should not be something done “to last minute, because we don’t know how long some of these new emerging infections will persist. “
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The outbreak of a potentially life-threatening new disease can make doctors want to do everything possible to save their patients, said Perlman, the Iowa professor. But human trials are essential to understand how a drug against a virus will work. .
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Experimental drugs that have not been tested in human trials can harm patients, Perlman said. However, the use of approved medications still leaves the door open to important questions, such as how large the dose should be.
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“It is very difficult when you are on the front line and the patient is sick and wants to do something,” he added.
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Experiments against the Ebola virus
Its performance was surpassed by two other medicines during the Ebola outbreak of 2018 in the Democratic Republic of the Congo. Researchers in China are testing the remdesivir in a randomized controlled trial against the outbreak.
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The increase in research and investment in these outbreaks can wreak havoc on pharmaceutical companies, especially if the virus disappears, as happened with SARS, explained Dr. Jesse Goodman, a professor of medicine at Georgetown University in Washington, D.C. The federal government helps alleviate these costs with initiatives such as the Biomedical Advanced Research and Development Authority of the Department of Health and Human Services, which helps public-private partnerships to develop drugs against threats to public health.
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Due to the volatility of the outbreaks, “it turns out difficult for companies to really justify investments“in specific therapies, said Dr. Amesh Adalja, an infectious disease specialist and a member of the Johns Hopkins Center for Health Safety in Baltimore.
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Goodman said that one of the lessons learned from the previous outbreaks is the need to invest more in the infrastructure needed to carry out clinical trials, such as doctors, laboratories and systems that allow them to share samples. Looking ahead, the World Health Organization tries to provide countries with the necessary means to quickly begin investigating a disease in the event of an outbreak.
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“The time to prepare for clinical studies is not in the middle of an outbreak,” said Goodman, a former scientist at the Food and Drug Administration (FDA). “It’s much earlier.”
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This story was produced by Kaiser Health News, an editorially independent program of the Kaiser Family Foundation not related to Kaiser Permanente.
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