Repurposed Drugs for COVID-19 Treatment
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Abstract
The outbreak of Covid-19 has increasingly affected an alarming number of patients and deaths around the world. The case-fatality rate is about 1.4% and up to 14.8% in people age80 and older. In this situation, the search for new drugs is urgently needed to combat new outbreaks but it will take years to develop a new drug from scratch. The repurposing of approved drugs has become a strategy for prompt response to emerging infectious diseases. A number of drugs have been selected for further development as COVID-19 treatment, including malaria drugs (chloroquine and hydroxychloroquine), anthelmintics (ivermectin), and influenza (favipiravir) and the herb Andrographis paniculata, etc. There is sufficient evidence that the World Health Organization has recommended against the use of malaria drugs. For other drugs, most of the available evidence has been rated as low-certainty because of imprecision in most outcomes with wide confidence intervals and there were serious concerns related to the risk of bias on study design. The quality of research for repurposed drug development should be the same as those of new drug development. The data should clearly demonstrate evidence of efficacy and safety of the drug. Scientific and ethical validity of clinical research is therefore essential. Future studies should focus on quality and appropriate study design, such a a double-blinded randomized-controlled trial (RCT) with sufficient power and appropriate outcome measures for patients with varying degrees of severity. In addition, a dose finding study may be needed to determine the appropriate dose for COVID-19. This paper presents four important clinical studies of repurposed antivirals that are being used in Thailand officially or unofficially. The information may assist in the decision to use, discontinue or further develop these drugs for COVID-19.
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