A Fast-Moving Virus Pits Treating Patients Against Finding a Cure
The frenzied hunt for drugs to ease Covid-19 could make it more difficult for scientists to find lasting treatments.
Pharmaceutical-research experts are raising concerns that attempts to offer desperate coronavirus patients some form of treatment may hobble crucial studies of which drugs actually work and which ones don't.
More than 100 off-the-shelf and experimental therapies are being tested either formally or informally for the coronavirus disease, including hydroxychloroquine, the antimalarial touted as a treatment by President Donald Trump, and remdesivir, an experimental drug from biotechnology company Gilead Sciences Inc. There are so many even coronavirus experts can barely keep track.
The huge field of potential treatments represents a mobilization of medical science that has few historical parallels. But with tens of thousands of patients in the U.S. hospitalized and no proven drugs to treat them, the crisis has exacerbated an always-present tension in the parallel worlds of caring for patients and looking for new therapies: that what might seem best for an individual patient can undercut a research effort that will benefit the greater public good.
The rush to use hydroxychloroquine before the evidence is in illustrates the problem. Much of the public’s excitement over it stems from a tiny French study that was shared on Twitter by Trump and others. U.S. researchers say it is full of methodological flaws. Among other weaknesses, it didn't look at whether the drug can keep patients out of the ICU.
Hydroxychloroquine, which is also used to treat rheumatoid arthritis and lupus, has been shown to inhibit coronaviruses in a test tube. But a close chemical relative, chloroquine, has been tested in human trials against viral diseases including influenza, dengue fever and chikungunya. It has repeatedly failed.
“We need to be true to the science and make sure that the proper trials are done so that we can really understand what works and what doesn’t,” Rochelle Walensky, chief of the infectious-diseases division at Massachusetts General Hospital, said on a call with reporters Friday. She said randomized clinical trials, the scientific gold standard for studying drugs, are essential to make sure doctors understand proper treatments.
“I am worried that we are repeating what happened with Ebola,” says Andre Kalil, an infectious-disease doctor at the University of Nebraska Medical Center. “A lot of people are being given unproven and unsafe drugs without any controls.”
If doctors keep using drugs without carefully testing, “the Covid-19 outbreak is going to finish and we are going to know absolutely nothing about which drugs harmed and which drugs helped,” he said.
Against viruses, “the track record of this drug is really poor” said Nebraska's Kalil. Hydroxychloroquine may trigger heart arrhythmias and even liver problems, which would be dangerous for elderly patients with cardiovascular problems who tend to be most sickened by Covid-19.
Several U.S. trials of hydroxychloroquine have recently begun. Some of the largest are focused on whether the drug helps prevent the disease in people who have been exposed to Covid-19, while others are exploring whether it will alleviate symptoms of the disease. Preliminary data could be available as soon as early May.
Antiviral researchers say a clear answer on whether Gilead’s remdesivir helps patients with coronavirus is more likely in the near term.
In February, weeks before the coronavirus pandemic exploded in the U.S., the National Institutes of Health began a trial comparing remdesivir with a placebo in 440 hospitalized patients. Half get remdesivir and half get a placebo. The trial has enrolled patients rapidly as the outbreak widened, and results could come by the end of this month. (Among the researchers involved in that study are Emory’s Mehta and Nebraska’s Kalil.)
Author: Robert Langreth and Riley Griffin
Published April 5, 2020 https://www.bloomberg.com/news/articles/2020-04-05/covid-19-treating-patients-finding-cure-chloroquine-remdesivir