How drugs dished out by GPs for everything from head lice to diabetes could be the future of fighting Covid

·5-min read
covid drugs
covid drugs

Britain has led the world in finding drugs that can help save the lives of people on death’s door with Covid.

Already, the UK has approved the steroid dexamethasone and the arthritis drug tocilizumab following trials. Together, they can lower the risk of death in the sickest patients by around 40 per cent.

Yet we may be approaching a time when Covid could be largely treated by the GP, with the majority of patients never needing hospital treatment.

This week, Japan became the first country to grant full approval for the use of Regeneron’s casirivimab and imdevimab antibody cocktail to treat patients with mild to moderate Covid-19, a sign that treatments are heading out of the ward and into the surgery.

The drug not only reduces viral load by 90 per cent, preventing the disease getting worse, but appears to stop people picking up the virus in the first place - even when they live in the same house as a carrier.

Excitement is also building around the GlaxoSmithKline monoclonal antibody sotrovimab, an early treatment drug that stops high-risk patients from being hospitalised once they catch Covid.

The drug is already in use in the US, and this week the European Commission agreed a joint purchase agreement for 200,000 doses, after the European Medicines Agency granted emergency authorisation.

Trial results released last month show that the drug lowers the risk of hospitalisation, or death, for high-risk groups by 79 per cent - a huge reduction, which could have a major impact on the course of the pandemic and offer another option for people unwilling or unable to be vaccinated.

“As the Covid-19 landscape continues to evolve and we meet new challenges – such as the delta variant spreading across the globe – there remains an urgent need for treatment options to help those who do get sick to potentially avoid hospitalisation or death,” said George Katzourakis, the senior vice president, Europe, of GSK.

Sotrovimab works by attaching to the spike protein of coronavirus, limiting its ability to enter the body’s cells. Crucially, the antibody was designed to keep working even if the virus evolves, and in the lab has been shown to work well against the delta and beta variants.

Although GSK has not yet applied for UK approval, trials closer to home could also bring a raft of new drugs capable of stopping Covid in its tracks.

Oxford University leads the way

Oxford University’s Principle trial is looking for drugs that can be repurposed for Covid, and has already discovered that early treatment with the inhaled asthma drug budesonide shortens recovery time by roughly three days in patients who are at higher risk of severe illness.

Now the Oxford team has moved on to the head lice drug ivermectin, which has been available in tablet form since the 1980s and is widely used in medicated shampoos.

In March 2020, researchers at Monash University, Australia, reported that ivermectin appeared to lower virus replication by 5,000-fold, and some countries such as India began to prescribe it as a prophylactic, claiming it was helping to keep cases low.

However poor trial data led the World Health Organisation to caution against using the drug, a decision that has infuriated some clinicians.

This week, a Cochrane Review found there is still not enough evidence to show that ivermectin works, but Oxford hopes to have an answer by next year.

Prof Chris Butler, the joint chief investigator of the Principle trial, said: “Ivermectin is readily available globally, has been in wide use for many other infectious conditions so it’s a well-known medicine with a good safety profile, and because of the early promising results in some studies it is already being widely used to treat Covid-19 in several countries.

“By including ivermectin in a large-scale trial like Principle, we hope to generate robust evidence to determine how effective the treatment is against Covid-19, and whether there are benefits or harms associated with its use.”

Finding drugs that fight viruses is tricky because they are not technically alive, and instead use the machinery inside the cells of other organisms to reproduce.

While antibiotics can kill bacteria, viruses have effectively assimilated with humans, so killing them risks also harming us.

To get round the problem of not attacking the body's own cells, scientists look for proteins and enzymes that are specific to the virus.

Oxford is also investigating the drug favipiravir, an antiviral drug that has been licensed in Japan since 2014 to treat influenza and which works by preventing an enzyme from helping viral replication.

The drug has already shown positive results against coronavirus in laboratory and animal studies, with small pilot studies in humans demonstrating some benefit in reducing symptoms and the duration of illness.

Affordable treatments accessible to all

Britain could still have more in-hospital treatments up its sleeve. This week, the Oxford Recovery trial announced it would investigate whether the diabetes drug empagliflozin could protect against organ damage and improve the chance of recovery for patients with Covid.

Empagliflozin works by reducing the amount of glucose absorbed by the body, helping to stabilise metabolic pathways, reduce inflammation and improve heart and blood vessel function.

Prof Sir Peter Horby, the co-chief investigator, said: “The pandemic still has a long way to run, and whilst Covid-19 continues to claim lives, we will continue our quest to find new, affordable treatments that are accessible to all.”

The Recovery trial is also currently investigating baricitinib, an immunomodulatory drug used in rheumatoid arthritis and dimethyl fumarate which is commonly used for psoriasis and multiple sclerosis.

There are currently thousands of clinical trials of Covid therapies taking place across the globe. With the whole world searching for treatments, it is only a matter of time before there is a breakthrough that could turn coronavirus into a far less deadly disease.

Israeli scientists even believe they may have found a cure, after nobody died in a trial of the inhaled drug EXO-CD24 that prevents the deadly overreaction by the immune system in late stage Covid. Larger trials are ongoing.

As concerns now move to variants and waning immunity, it is comforting to know that there is another route out of this pandemic even if vaccines do not give us the protection that we had hoped.

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