Race for COVID drugs dogged by false promises
TORONTO — More than a year after COVID-19 emerged, few therapies exist and many that do are expensive, cumbersome and unproven, say experts who suggest disjointed data, funding and communication are derailing efforts to tamp down disease.
While warp speed efforts to develop vaccines have produced several promising options in mere months, there’s been comparatively little push for treatment tools to cut severe cases and deaths that are crippling healthcare systems, says COVID19 researcher Dr. Jordan Feld, a liver specialist at UHN’s Toronto Centre for Liver Disease.
The urgency for effective drugs has only become more intense amid Canada’s vaccine deployment debacle and the rise of more infectious variants, adds Feld, whose research into a promising antiviral treatment was recently published in Lancet Respiratory Medicine.
“It would have been nice to have seen a little more co-ordinated effort to try to develop antiviral therapies early on, and that’s probably hampered all of our efforts at developing therapeutics,” says Feld, calling for more national and global co-ordination of clinical studies and data sharing.
Feld’s research centres on a protein that can activate cellular pathways to kill invading viruses. Early data on injecting the drug, called peginterferon-lambda, into COVID patients found it significantly sped recovery for patients enrolled in a small Phase 2 clinical trial.
The 30 participants who received the experimental drug were four times more likely to clear the infection within a week than those in the placebo group.
Slightly different studies on peginterferonlambda include efforts at the University of Toronto, New York’s Mount Sinai medical school, and Johns Hopkins, Harvard and Stanford universities, says Feld.
But all were planned independently when a shared effort could have allowed scientists to collaborate on trial design and divide work based on expertise and local situations, he says. He envisions an approach similar to the Manhattan Project, which was a Second World War-era effort to develop an atomic weapon.
“This is a national emergency, we need to develop the bomb — in this case we need to develop the antiviral bomb or the vaccine bomb,” he says.
Most clinicians have a relatively scant arsenal to fight COVID-19, agrees Hamilton infectious disease physician Zain Chagla.
“The fact that we have millions and millions of patients across the world and our clinical trial data is still only coming out with thousands of patients’ experience is an absolute shame,” says Chagla, an associate professor of medicine at McMaster University.
“We should have had more patients enrolled in clinical trials to robustly answer these questions of what therapies worked or didn’t work.”
Dexamethasone, given to hospitalized patients who need help breathing, has been among the most significant therapies to tackle COVID-19 in a field littered with false promises.
Feld points to hydroxychloroquine as the poster child of misguided, politically motivated treatment bids, while more recently, unproven hype has surrounded the antiparasitic drug Ivermectin. Premature promotion does all scientific research a disservice, he says.
“That probably actually hinders studies from being done, because when people feel like it’s good or bad — and especially if that changes with their political leanings — that may really affect the way you get people enrolling in a trial or not enrolling in a trial,” says Feld.
On top of that, Chagla says it’s been hard to keep some clinicians from giving unproven therapies to suffering patients with no other options.
“That was the issue in the beginning, for sure — people felt uncomfortable having a patient on a ventilator without giving them hydroxychloroquine or giving them some other drug to make it feel like they’re doing something based on a few case reports and a few theories.”
Just last week, the Quebec government cautioned clinicians against embracing colchicine as a COVID-19 therapy after the Montreal Heart Institute touted the common gout medication as “a major scientific discovery.”
Quebec’s National Institute for Excellence in Health and Social Services acknowledged the institute’s study showed positive results, but said the benefit was too small.
While a number of Canadian study sites are part of a World Health Organization trial known as Solidarity, Chagla says data from every Canadian COVID-19 patient should be shared for vital learning along the lines of the U.K.’s national clinical Recovery trial.
“We don’t know other than dexamethasone whether or not these therapies work in significant numbers. Remdesivir maybe, but it’s still even controversial there. Why are we not doing this now, 11 months later? We have the talent, we have the personnel, we have the patients, we have the health-care staff,” says Chagla.
“We should be able to be co-ordinating such that every patient that’s hospitalized for COVID-19 receives a therapy that informs practice for the next patient.”
Health Canada has authorized just two drugs specifically for COVID-19 treatment — Gilead Sciences’ remdesivir and Eli Lilly’s bamlanivimab — and is fast-tracking the review of others.
But while bamlanivimab claims to ease and prevent COVID-19 symptoms among mild-to-moderate cases, there’s limited safety data, it costs US$1,250 per dose and is difficult to administer because it involves an hour-long intravenous infusion which could redirect front-line medical staff.
British Columbia’s Health Minister Adrian Dix said Monday a clinical trial would examine bamlanivimab’s potential at Surrey Memorial Hospital, and Alberta Health Services says it’s considering a trial to determine “potential for benefit and feasibility of use.”
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.
“Vaccines are great for preventing people from getting the infection, but for those who do still get the infection it’s important to have therapeutics to treat them,” Feld says.
What kind of day will today be? To find out what the stars say, read the forecast given for your birth sign. For Wed., Feb. 10, 2021 ARIES (March 21 to April 19)
An older friend or someone more experienced than you might surprise you today or have surprising news. Stay flexible and be ready to respond.
TAURUS (April 20 to May 20)
Be careful when dealing with bosses, parents, teachers and people in authority today because something unexpected might catch you off guard. If you play your cards right, it could be good.
GEMINI (May 21 to June 20)
Something unusual might occur today that relates to people far away or people from another country or a different culture. It might be a change to travel plans.
CANCER (June 21 to July 22)
Some kind of change that affects shared property or your dealings with the wealth and resources of your partner or a friend might favor you today. Be alert and make sure you know what's happening.
LEO (July 23 to Aug. 22)
Relations with partners and close friends are up in the air today. Expect some surprises. Someone might suggest something unusual, but you might like it.
VIRGO (Aug. 23 to Sept. 22)
Although your work routine might be interrupted today, nevertheless, you will look for ways to make things better. Some of you might suddenly have work-related travel.
LIBRA (Sept. 23 to Oct. 22)
Parents should be vigilant about their kids today because this could be an accident-prone day for them. An unexpected invitation to a social event is likely (r perhaps a cancellation).
SCORPIO (Oct. 23 to Nov. 21)
Your home routine will be interrupted today, probably something related to Mom or a female relative. Whatever happens might expand things with your family.
SAGITTARIUS (Nov. 22 to Dec. 21)
This is a mildly accident-prone day, so pay attention to everything you say and do. Meanwhile, you are full of bright, clever ideas! Why not run something up the flagpole to see if anyone salutes?
CAPRICORN (Dec. 22 to Jan. 19)
Keep an eye on your finances and your possessions today because something unexpected could impact them. You might find money; you might lose money. Expect a surprise!
AQUARIUS (Jan. 20 to Feb. 18)
This is an electric, exciting day! Unexpected events will catch you off guard, but things could be fun! Give yourself extra time so you can deal with some surprises.
PISCES (Feb. 19 to March 20)
Today is full of high energy and surprises. You can feel this. Be smart and give yourself time to deal with the unexpected. YOU BORN TODAY: You are independent, strong and friendly. You take the lead. You like to get to know others. This is your time of harvest, when you will start to reap the benefits of the seeds that you planted in the past decade. You deserve this time of success! As a result, you might enjoy increased influence and leadership in all your relationships.
BIRTHDATE OF: Yara Shahidi, actress; Laura Dern, actress; Vince Gilligan, director.