Doctors using repurposed drugs to treat COVID-19
Researchers pressed forward Thursday with plans for clinical trials using plasma from recovered coronavirus patients to help those sick with the disease. At the same time, some U.S. doctors were using two so-called “repurposed drugs” on an experimental, compassionate basis.
The two drugs, chloroquine and hydroxychloroquine, have already been found safe for the treatment of other diseases and are now being used to treat hospitalized COVID-19 patients who are considered to be moderately ill.
The hope is that the drug would help a patient who already has the disease improve and pull through.
The treatment does not have a stamp of approval from the U.S. Food and Drug Administration but can be employed by doctors caring for the seriously ill when no other treatment is available.
“I think the solution is finding drugs that can be repurposed and trying them like the Chinese did,” said Rodney Willoughby Jr., infectious disease specialist at Children’s Wisconsin hospital and the Medical College of Wisconsin. Willoughby is well-known for helping save Jeanna Giese, a Fond du Lac girl, who in 2004 became the first person in the world to survive rabies without vaccine.
“There are doctors in this country who are using chloroquine and hydroxychloroquine.”
The potential downside to the two drugs is the uncertainty surrounding the quality of the Chinese data supporting their use against COVID-19, said Jeffrey Henderson, an associate professor of medicine and molecular biology at the Washington University School of Medicine in St. Louis.
Both drugs are used to treat malaria and are licensed in the U.S.
Other drugs also being used for “experimental compassionate” treatment of COVID-19 include remdesivir, which was unsuccessful when tested against Ebola, and is now in clinical trials in China; and tocilizumab, which is licensed and used to treat rheumatoid arthritis.
Moving ahead on recovered patients’ plasma
Meanwhile, researchers at Johns Hopkins Bloomberg School of Public Health in Baltimore, Mayo Clinic in Rochester, Minnesota, and Washington University School of Medicine in St. Louis confirmed that their institutions will be centers for clinical trials of plasma from COVID-19 patients who have recovered. The New York Blood Center is partnering with Johns Hopkins on the project.
“The most important thing is that there is very little evidence that (the plasma) can make things worse. That’s why you’ve got to take a shot,” said Michael Joyner, who has been working to set up trials at Mayo Clinic, where he works as a professor of anesthesiology.
“We have a chance to keep this from becoming a complete disaster.”
Joyner said Mayo Clinic’s request to begin emergency trials of survivor plasma will go out Friday to the FDA.
He said the push for clinical trials has been a grassroots effort by a large number of scientists.
“This shows the power of a good idea and how it can be amplified,” Joyner said. “I was on a conference call yesterday with over 50 people. They’re checking their egos at the door. Nobody is worrying about credit.”
The two distinct schools of thought behind the effort to launch clinical trials and the experimental use of repurposed drugs illustrate the desperation of the situation. Doctors are trying to quell a pandemic without a vaccine and without a proven treatment.
“I’m skeptical,” Willoughby said of the effort to use plasma from recovering COVID-19 patients. “You need an awful lot of (plasma).”
He said one of the practical problems is that to get substantial numbers of COVID-19-fighting antibodies, the recovering patient has to have been very sick.
“You have more immune bang for your buck the worse the disease has been,” he said.
That means that good news — the large percentage of people infected with the virus who suffer only mild disease — would actually work against a treatment using plasma.
Another key concern, he said, is that each donation of survivor plasma would have to be rigorously tested before it could be used.
Testing, he said, should take place in labs that are Biosafety Level 3, the level for handling microbes that, if inhaled, can cause potentially lethal disease. Researchers who work in a Biosafety Level 3 lab must don solid protective clothing that cannot be worn outside of the laboratory. After each use, the clothing must be discarded or decontaminated.
As important as developing a treatment is, Willoughby stressed that “what’s straining us medically is the inability to do testing. We are not testing our own health care personnel unless they are actually a patient.”
Researchers pursuing trials of survivor plasma believe that the size of the U.S. blood supply and its network of blood banks should help to overcome some of the practical obstacles.
At the moment, however, “we don’t have a lot of people who’ve recovered to be able to donate plasma,” said Henderson at the Washington University School of Medicine in St. Louis. “Much depends on how many donors we’ll be able to find, and how much plasma we’ll be able to use.”
Asked about his institution’s application to the FDA, Henderson said, “It’s going in as we speak.” He said the school of medicine in St. Louis is hoping to test survivor plasma on about 40 patients who are moderately ill “and at risk for worsening. We’re trying to prevent them from having to go on a ventilator.”
Collaborate and communicate
So, what’s to prevent a local hospital from teaming up with a blood bank to provide survivor plasma for experimental compassionate use?
“As far as I can see,” said Henderson, “the only barrier to this is the law.”
He said any hospital that put into practice such an effort would be violating the complex laws that govern blood banking.
In 2004, when he was medical resident, Henderson presented a study looking at the experience of a local hospital heavily involved in treating patients with Severe Acute Respiratory Distress Syndrome.
“Even then I didn’t imagine it would happen to me,” he said referring to the situation the U.S. now faces.
Doctors and researchers on both sides of the divide between survivor plasma or repurposed drugs agreed that what is propelling the fight against COVID-19 is an extraordinary level of teamwork in the scientific and medical communities.
“There’s no better hope for the human race than the way we collaborate and communicate,” Willoughby said.