COVID-19 drug repurposing research
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|Part of a series on the|
|2019–20 coronavirus pandemic|
Drug repositioning (also called drug repurposing) – the investigation of existing drugs for new therapeutic purposes – is one line of scientific research which is followed to develop safe and effective COVID-19 treatments. Other research directions include the development of a COVID-19 vaccine.
Several existing antiviral medications, previously developed or used as treatments for Severe acute respiratory syndrome (SARS), Middle East respiratory syndrome (MERS), HIV/AIDS, and malaria, are being researched as COVID-19 treatments, with some moving into clinical trials.
In a statement to the journal Nature Biotechnology in February 2020, US National Institutes of Health Viral Ecology Unit chief Vincent Munster said, "The general genomic layout and the general replication kinetics and the biology of the MERS, SARS and [SARS-CoV-2] viruses are very similar, so testing drugs which target relatively generic parts of these coronaviruses is a logical step".
Drug repositioning (also known as drug repurposing, re-profiling, re-tasking or therapeutic switching) is the repurposing of an approved drug for the treatment of another disease or medical condition.
Reusing approved medications has the following benefits:
- Faster legislative and medical approval
- Existing body of scientific literature (particularly Contraindications and Drug Interactions)
Chloroquine is an anti-malarial medication that is also used against some auto-immune diseases. On 18 March, the WHO announced that chloroquine and the related hydroxychloroquine would be among the four drugs studied as part of the Solidarity clinical trial. New York governor Andrew Cuomo announced that New York State trials of chloroquine and hydroxychloroquine would begin on 24 March.
On 22 March 2020, Italy approved the drug for experimental use against COVID-19 and began conducting trials in the three regions most affected by the disease. The Italian Pharmaceutical Agency reminded the public that the existing evidence in support of the drug is scant and preliminary.
One study of lopinavir/ritonavir (Keletra), a combination of the antivirals lopinavir and ritonavir, concluded that "no benefit was observed". The drugs were designed to inhibit HIV from replicating by binding to the protease. A team of researchers at the University of Colorado are trying to modify the drugs to find a compound that will bind with the protease of COVID-19.
There are criticisms within the scientific community about directing resources to repurposing drugs specifically developed for HIV/AIDS, since it is unlikely that a drug developed specifically against HIV will work for a very different virus (it is more likely that general-purpose antivirals will work). The WHO included lopinavir/ritonavir in the international Solidarity trial.
Cleveland University Hospitals started conducting two clinical trials for remdesivir, one for people with moderate illness and another for those with more severe illness. The Feinstein Institute of the Northwell Health system partnered with Gilead Sciences on phase III clinical trials for remdesivir.
Intravenous vitamin C
There are three ongoing clinical trials of intravenous vitamin C for people who are hospitalized and severely ill with COVID-19; two placebo controlled (China, Canada) and one with no control (Italy). A review of vitamin C administration to critically ill patients (burns, trauma, sepsis) reported a tendency towards a mortality reduction when intravenous, high-dose, vitamin C monotherapy was administered. Intravenous vitamin C achieves a much higher plasma and tissue content than is possible with orally consumed vitamin C.
Japan's National Center for Global Health and Medicine (NCGM) is planning a clinical trial for Teijin's Alvesco (ciclesonide), an inhaled corticosteroid for asthma, for the treatment of pre-symptomatic patients infected with the novel coronavirus. 
Since SARS-CoV-2 is a virus, considerable scientific attention has been focused on repurposing approved anti-viral drugs that were developed for prior outbreaks such as MERS, SARS, and West Nile virus.
Anti malarial agents
- Ribavirin: ribavirin was recommended for COVID-19 treatment according to Chinese 7th edition guidelines
- Umifenovir: umifenovir was recommended for COVID-19 treatment according to Chinese 7th edition guidelines
Drugs originally developed for SARS
- APN01 (ACE2 protein decoy)
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|✔️||Significant anti-viral activity|
|✘||No Significant anti-viral activity|
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