SARS-CoV-2, also known as COVID-19, is a coronavirus that causes, sometimes severe, respiratory illness. The first reported case was on December 31, 2019, in Wuhan, China, and the outbreak has since been declared a Public Health Emergency by the World Health Organization (WHO). Today, there are more than one million confirmed cases worldwide.
Currently, no medications have been approved for treating SARS-CoV-2, but hundreds of studies are looking for potential treatments. WHO has now started the SOLIDARITY Trial, a worldwide study testing the four most promising drugs to fight this new virus. Here we will take a look at some of the evidence behind these medications.
Chloroquine and Hydroxychloroquine
Chloroquine (Aralen) and hydroxychloroquine (Plaquenil) are antimalarial drugs that may disrupt the entry and release of SARS-CoV-2. An initial trial in China with chloroquine showed potential for improving patients’ lung function. Researchers in France then took up the call and performed a non-randomized 14-day trial of hydroxychloroquine alone or a combination of hydroxychloroquine with azithromycin, an antibiotic, versus patients receiving the standard of care. Treatment with hydroxychloroquine and the combination of hydroxychloroquine and azithromycin helped more patients clear the virus from their system in 6 days (57.1% of hydroxychloroquine-treated and 100% of hydroxychloroquine-azithromycin, P<0.001).
In response to these trials, the U.S. Food and Drug Administration (FDA) issued an emergency use authorization for both antimalarial drugs, 20 new studies have been started in China, and China has included chloroquine in its recommendations for the prevention and treatment of SARS-CoV-2.
Lopinavir/Ritonavir (Kaletra) is an approved HIV protease inhibitor that was investigated as a treatment for SARS in 2003. The LOTUS Trial in China evaluated the use of this medication in 199 patients but did not find any clinical benefit. Despite this disappointing outcome, China still updated its clinical guidance to recommend the use of this medication in patients with SARS-CoV-2 based on the secondary outcome that it could shorten patients’ stay in the ICU.
Lopinavir/Ritonavir plus Interferon-beta
This combination of drugs is used as a first-line therapy for Multiple Sclerosis. Interferon beta is a common choice when treating an unknown infection, and it may inhibit the replication of SARS-CoV-2. Researchers in China are now testing this new combination.
Remdesivir, an antiviral originally developed to treat Ebola, has recently been repurposed for SARS-CoV-2. In animal studies, it showed activity against both MERS and SARS, leading researchers to believe it might be effective against SARS-COV-2. The maker of the drug, Gilead, now has two Phase 3 trials to test this theory. Trials are also under way in China and France.
The first patients have already been enrolled in the SOLIDARITY Trial. WHO is hoping the trial will “dramatically cut the time needed to generate robust evidence about what drugs work.” More than 45 countries have signed up to contribute to the trial.