Promising new Covid drugs are in the pipeline. Here they are

As the Covid-19 pandemic continues to roil across the globe, scientists and healthcare professionals are still searching for that Holy Grail — a cure.

In the 18 months since the pandemic began, numerous drugs have been tried on patients to see if they have any outcome in preventing serious illness or death, with mixed results.

This has led to desperate patients and their families grasping unproven medications such as hydroxychloroquine and the animal anti-parasite drug ivermectin.

There are three good medications for treating Covid-19, said clinical infectious diseases epidemiologist Prof Salim Abdool Karim, two of which are available in SA. 

“We have steroids, dexamethasone being the poster child for the steroids,” he said, adding that these reduced deaths by about 50%. 

There was also a drug called tocilizumab, a monoclonal antibody approved by the US Food and Drug Administration (FDA) to treat several autoimmune diseases.

“It is available in this country but I don’t think we use it enough,” said Abdool Karim.

“There have been several clinical trials and there’s been a peer review — a meta-analysis — that it works very well, reducing mortality by about 15% to 18%. So that’s about one in five deaths that are averted.”

Tocilizumab suppresses the inflammatory response. 

“You don’t die from the virus, you die from your own body overreacting to the virus,” he said.

That’s what leads to your lungs getting filled up with a gelatin-like substance because of all the pus in there from the immune reaction to the virus. It’s not the virus doing the damage, it’s yourself. It’s that cytokine storm. So IL-6 is a key part of that.

You don’t die from the virus, you die from your own body overreacting to the virus.

—  Prof Salim Abdool Karim

Finally, there were antibody treatments such as Regeneron, which reduced mortality. 

“But they’re very expensive, which is why they’re not readily available in this country,” he said.

The focus in SA has also been on developing vaccines rather than treatments for Covid-19.

Cape Town-based pharmaceutical manufacturer Biovac has entered into a partnership with vaccine developer ImmunityBio to manufacture the US firm’s candidate vaccine, while Aspen Pharmacare, the Gqeberha-based pharmaceutical manufacturer, is doing fill and finish work on Johnson & Johnson’s Covid-19 vaccine.

Stavros Nicolaou, Aspen’s senior executive responsible for strategic trade development, said the company was not developing any Covid-19 treatments.

“We were quite involved in the beginning because we have dexamethasone,” he said.

Dexamethasone is a long-acting steroid, the licensing rights for which Aspen acquired more than 10 years ago.

“In terms of therapeutics — the data-driven stuff — the thing that has been most successful in reducing mortality in an ICU setting has been dexamethasone,” he said.

Aspen was also heavily involved in supplying drugs such as muscle relaxants for patients who needed to be intubated to go on ventilators.

“Those patients need anaesthetics and muscle relaxants.”

Aspen’s focus would remain on expanding its vaccine capacity rather than therapeutics, he added.

At a therapeutic level, other companies were investigating antiviral drugs and monoclonal antibody treatments, and there was still ongoing research into repurposing older drugs for treating Covid-19.

“The track record on that has not been good,” said Nicolaou, noting that treatments such as hydroxychloroquine and ivermectin had started out showing some promise but had failed to deliver.

We know that if your vitamin D levels are low, then you might benefit from getting proper vitamin D.

—  Dr Angelique Coetzee

Meanwhile, healthcare workers continued to use various therapies that had been proven to help patients recover from Covid-19, said SA Medical Association chairperson Dr Angelique Coetzee.

“We know that if your vitamin D levels are low, then you might benefit from getting proper vitamin D,” she said, adding that it was vital for patients to test vitamin D levels first.

There was also a recent study on Luvox, an antidepressant medication used to treat obsessive compulsive disorder (OCD) in adults, which has shown some promise in preventing hospitalisation among Covid-19 patients, following a large study in Brazil.

“The thing with Luvox is that it has an anti-inflammatory component,” said Coetzee.

However the study had not been peer reviewed or published, she added.

Coetzee also noted that there was a nasal spray under development trials in Australia.

In early tests on ferrets, the spray, called INNA-05, was shown to reduce levels of active virus in the animals’ nasal passages by some 96%.

Human trials were anticipated, pending funding, ENA Respiratory, the developer said.

Phase one human trials subsequently started in Sydney on July 14.

Meanwhile, Israeli scientists are pinning their hopes on a new drug called EXO-CD24, which is being trialled in hospitals in Athens.

Early results showed that 29 out of 30 patients who received the EXO-CD24 treatment, recovered in three to five days.

The drug, which was developed by scientists Tel Aviv’s Sourasky Medical Centre, is based on a protein molecule called CD24, which helps regulate the mechanism responsible for the cytokine storm that causes poor outcomes in many Covid patients.