After months of inactivity, the world's largest international clinical trial, led by the World Health Organization (WHO), Solidarity, which is promising treatments against Covid-19, starts again with the trial of three other drugs for inpatients. All three drugs have been developed for other diseases, but will now be tested against coronavirus. These are the anti-cancer imatinib, the anti-malarial artesunate and the monoclonal antibody infliximab against autoimmune diseases.
The three drugs have already been shipped to Finland, the first country to start a new phase of the study called Solidarity Plus. Other countries are expected to follow soon, as more than 40 are already in the process of being approved by the relevant supervisory and bioethical authorities, according to "Science".
When the initial Solidarity study began last March, as the pandemic was "threatening", the goal was to test a number of drugs simultaneously in several countries. By the end of 2020 it had drawn conclusions about four drugs or combinations thereof (lopinavir / ritonavir, hydroxychloroquine, interferon-beta and remedesivir). All in all, they judged that they had no real benefit against coronavirus, with the result that the study was involved in months of negotiations with the pharmaceutical companies and delays (the final results for remedisivir are expected in a few weeks). Now it's time to start the study again with a new round of medication.
In addition to vaccines, to date only two drugs have been shown to reduce mortality in patients with severe Covid-19: Dexamethasone, a cheap steroid, and the tocilizumab monoclonal antibody. Both of these treatments "slow down" the self-destructive overreaction of the immune system against coronavirus infection.
The three new drugs being tested, selected by an independent panel of experts, also target the immune system rather than the SARS-CoV-2 virus itself. Imatinib is given orally to treat some leukemias and other cancers, but it can also protect the epithelium of the alveoli of the lungs. A controlled trial of 400 hospitalized patients in the Netherlands, published in June, showed that the drug reduced patients' intubation time and chance of death. The data were considered encouraging enough for the drug to be tested in the context of Solidarity Plus, as well as another international test (REMAP-CAP).
Infliximab is an antibody that is given only once for injection and blocks a mechanism in the immune system. So far it has been used in autoimmune diseases such as rheumatoid arthritis and inflammatory bowel disease. Some recent indications that it may help Covid-19, led to the decision to test this by Solidariy Plus.
Finally, artesunate, a derivative of artemisinin, which is very effective against malaria parasites, has also been shown to have antiviral activity against the new coronavirus in laboratory (non-clinical) studies. Solidarity Plus will try it for another reason, as the drug appears to reduce inflammation and "calm down" the overstimulated immune system, which results in damage to the lungs and other organs of patients with severe Covid-19.
Source: RES-EAP
