New Scientist 28Mar2020

News Coronavirus update

Drug search continues

There has been much enthusiasm for promising medicines, but it is unclear

if any will help those who really need them, reports Michael Le Page

DESPITE what you may have

heard, although several potential

drugs for covid-19 are being

trialled around the world, few

i:esults have been reported yet,

and wedon'tknowtfanycouki

help save people who are already

seriouslyillwhendJagnosed

Some enthusiastic: news stories

and claims being spiead on social

media are based cm little more

than anecdotal reports. However,

the World.Health Organization

(WHO) is coordinating an

fntematlonal trial of the most

promilmg drugs-and with case

numbers soaring. we shouki find

out soonifanyofthem work

"This trial.focuses cm the key

priority questions for publk:

health. Do any ofthae drugs

reduce the mortality? Do any of

these drugs reduce the time the

patlentis in hospital? And whether

or not the patients mceivingany

of the drugs needed ventilation

or an intensive care unit." said

ADaMaria Henao-Restrepo of the

WHO at a briefingon18March.

The WHOtrial will include

the long-used antimalarial

drugs chloroquine and

hydroxychloroquine, a new

antiviraldrugcalledremdesivir

andacomblnationoftwo

HIV drugs ca.Uedlopinavir and

ritonav.ir.1beHIV drugs will also

-What we need most
Is a drug that can save
llves when covfd-19 ls
identified in severe cases-

betestedincombinatl.onwtth an

antiviral.calledinter.ftm>n beta.

On 22 March. sevemlcountries

in Europe. including the UK,

brunched ac:ollaborativetrial

of the same drugs, which will

complement the WHO effort.

Tbereha.s been a tremendous

buzz about chloroquine after

it was highlighted fint by

us president Don11d

Tl'Wnpwuwrongabaat

th• drug chlaroqulM

entrepreneur Elon Musk and

then US president Donald Trump,

whowronglycJaimedttwas

already approved in the US

for treating covid-19.

There is some evidence that

chloroquine and the closely

related hydroxydlloroquine are

effective againsti:elatecl 'Viruses

sw:h as the one that causes SARS.

There have also been reports

from Chllla that chloroquJne

is beneBdal. when given to

people with covid-19 associated

pneumonia. but the findings

have yet to be published. '1tloob

promising," SaJS Robin May at the

UnivenityofBirmingham, UK.

However, some excitement

over these drugs stems from a

study of just42 people in France

that said those who received

hydrcmychloroquJne cleared the

coronavirua from theJrbodies

days faster, with the effect being

even greater in those also given

the antibioticaz.it:bromycin

(medRxiv. doi.org/dqbv).

The researchers speculated

that hydrox}'dlloroquine c:an

prevent infection as well, but

other researchers saythe small

size of the study and other issues

mean we can'ti:elyon its results.

What's more, while

hychmyc:hloroquineand

chloroquine are sate when

taken properly. there are already

repom of people O\'eldoeing

on chloroquine in an attempt

to protect themselves, which

cm cause lethal heart problems.

Meanwhile, people who need

this drug fur lupus or arthritis are

finding it bani to get hold of.

Hunting for antibodies

Even if chloroquine does stop

people becoming severely ill if

given when symptoms are still

mild, it wouldn't necessarily be

a game changer. Atthemoment,

most c:ountr.Ies are detecting

c:oronavirua infections only once

people develop severe symptoms,

sowhatweurgentlyneedisadrug

that can save lives at this stage.

"Whether that's going to aop

up is anyone's guess; says May.

Unfortunately, tt already seems

that the l.opinavir andrltonavir

combination doesn't do this. A

randomised trial in China found

no evidence of any benefit (NEJM,

doi.org/ggpc:ms). As for:R!Dldesivir,

the results of trials in China

haven't been made public yet.

Many other potential

treatments are bclng aplored,

particu]arlythe possibility of

developingantll>odies against

covid-19. Antibodies are the

I

proteinsourimmunesystems

use to kill the'Virus, but it tabs

weeksforourbodiestorampup

production after we are infected.

In theozy, injecting antibodies

made in afiM:t.oryshould be an

a effectivewayto both prevent

~ andtreatcovicl-19. US company

Regeneron says it bas aheady

identified hundreds of antibodies

against the coronavirus and plans

to startmas•producingthemost

potent ones in mid-April.

Another way to get antibodies

is toemac:tthemfromtheblood

of people who have recovered

from covfd-19. At least 250people

in Cllina have received treatments

made this way. According to the

Xinhua news agency. it was safe

andefl'ediw, butthefindingsdon't

yet appear to have been published.

All the approaches described

above are based on tiying to kill

the virus orpreventitrepllrattng.

However, it appears that most

deaths fromcovicl-19 arethe:resu1t

ofa aevereimmune reac:tionc:ailed

acytokine storm. So another path

is finding ways to prevent or

dampen this response. A small

study in onJy19 people suggests

thatanimmunosuppressive

anttbodyc:alled toclllzwnab

is hJghlyefl'ective (ChinaXiv,

DOI: 10.t20741'202003-00026).

This approach c:an be risky,

though. "bmnunothenpy

is reailycbaUenging because

you'remessingwith the immune

systemofpeoplewhoarevery

sick," says May. I