Why are there so few COVID- 19 drugs?
When future historians recount the medical advances of the 21st century, a crowning achievement will surely be the swift development of COVID- 19 vaccines to prevent the disease.
So why is it so hard to deliver drugs that can treat it?
Despite more than 14 million infections and 277,825 deaths, the United States has struggled to channel its expertise, energy, focus and resources into clinical trials for medicines that could reduce misery and save lives.
“We need better drugs. We want this to be an entirely curable disease,” said Dr. Annie F. Luetkemeyer, an infectious disease physician at Zuckerberg San Francisco General Hospital.
There is no cure yet for COVID19. So far, the nation has produced only four new therapies that seem to ease the symptoms — remdesivir, dexamethasone and two types of monoclonal antibody treatments.
For the vast majority of patients with mild or moderate disease, there’s not a single drug that is unequivocally effective enough for routine use, according to the Infectious Diseases Society of America.
It’s not because we’re not trying. With speed borne of desperation, about 700 potential drugs are being tested. Hundreds of trials are underway.
But it’s difficult to recruit patients; unlike healthy vaccine volunteers, infected people just want to stay home. And until recently, there has been little nationwide coordination of trials, wasting time, money and effort. Many studies have been too small to yield answers. Meanwhile, some drug candidates have been overhyped, while other promising agents are in limbo, delayed due to a backlog in federal reviews.
The result? Fewer than 10% of the nation’s COVID- 19 patients have enrolled in high- quality clinical trials for treatments that would reveal what works and what doesn’t, according to health policy expert Dr. Vinay Prasad of UC San Francisco.
To be sure, the struggle to find a breakthrough drug is not unique to this disease. Only one of every 10 potential therapies eventually wins FDA approval. The failure rate is even higher for drugs targeting complex and poorly understood conditions like COVID- 19.
Anti- viral therapies are especially hard to find, according to Stanford infectious disease epidemiologist Dr. Yvonne Maldonado. Because viruses reside in human cells, there’s the risk that any agent that kills the virus might also harm the cell, she said.
And COVID- 19 has a second deadly phase: immune overreaction. But a drug that suppresses the immune response may do more harm than good, impairing the body’s ability to control the virus.
“We face multiple challenges,” said Dr. Aruna Subramanian of Stanford Medicine, an infectious disease expert who is leading several clinical trials on COVID treatments.
While research is moving far faster than in the past, “we’d like it to go even faster,” she said. “We have lots of great ideas and lots of great science.”
What are the problems in finding treatments? Interviews with experts revealed these shortcomings:
In the first month or two, as cases surged, doctors were focused on patient care. “We were just trying to keep the hospital functioning. … It was difficult to think about getting clinical trials going,” critical care expert Dr. Neil Schluger of Columbia University Medical Center told the journal Science.