It seems like every week another drug grabs the headlines in the ongoing battle against COVID-19. Keeping track of where drugs stand in trials and which ones failed after promising starts could be a full-time job. As a community pharmacist, you have plenty of other demands on your time, including answering questions about the potential for a cure from your patients. We’ve got you covered.

Two quinine derivatives took the early lead and have again recently dominated discussion about drugs for the novel coronavirus. Stockpiling of hydroxychloroquine and chloroquine, both old malaria drugs most often used in the United States to treat lupus and rheumatoid arthritis, continues to contribute to shortages. Some preliminary trials combined the drugs with azithromycin, leading to shortages of the standby antibiotic as well. 

Recent trials, however, have demonstrated that the drugs increase the risk of death in patients with COVID-19. All three drugs are known to prolong QT intervals, raising the risk of sudden cardiac arrest and other complications. In late April, the FDA cautioned against use of hydroxychloroquine or chloroquine for COVID-19 outside of a hospital setting or a clinical trial due to risk of heart rhythm problems. Hospitals that had initially prescribed the drugs to patients have discontinued their routine use as they saw mortality rates rise. The drugs are particularly dangerous in patients with existing heart and kidney disease.

News of a clinical trial for COVID-19 that uses a common heartburn drug, famotidine, has led to shortages of that OTC medication as well. Preliminary results from a retrospective study at Columbia University Irving Medical Center-New York Presbyterian Hospital published May 19 on medRxiv found famotidine was “associated with reduced risk of intubation or death in hospitalized COVID-19 patients.” The results have not been peer-reviewed but showed a more than 50% reduction in death or intubation.

As reported here last week, a three-drug combination of interferon beta-1b, lopinavir-ritonavir, and ribavirin appeared to reduce the length of hospitalization in patients when given to patients with mild-to-moderate cases of COVID-19 in a phase II clinical trial. Results of the small, randomized, controlled trial were published in the Lancet. The researchers noted that the combo was well tolerated, relieved symptoms, and reduced transmissibility. 

Remdesivir, originally developed to treat Ebola but never approved, has shown mixed results. In one trial conducted by the National Institutes of Health, but as yet unpublished, it appeared to speed time to recovery by about 31% compared with placebo, leading to an emergency-use authorization by the FDA for hospitalized patients with COVID-19 who require oxygen. 

In contrast, a recently published trial conducted in 10 hospitals in China found that “remdesivir use was not associated with a difference in time to clinical improvement.”

A San Francisco-based team mapped existing drugs against human proteins needed by the novel coronavirus. Their analysis turned up a drug called PB28, developed for cancer treatment. The drug appears to be 20 times more powerful than the quinine derivatives in combatting the virus and has a much better safety profile. So far, research has been restricted to cell cultures.

Other researchers are working to develop entirely new treatments for the disease. One group in the Netherlands has identified a human antibody that neutralizes both SARS-CoV-2, the coronavirus that causes COVID-19 infection, as well as SARS-CoV, the pathogen that causes severe acute respiratory syndrome (SARS), in cultured cells.

Another new potential treatment is being studied in China. The drug candidate inhibits a SARS-CoV-2 protease, an essential enzyme for the virus. Testing continues on the agent, currently named 11a.  

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