Over the past 12 months, much of the world’s media has focused on the race for an effective vaccine against SARS-CoV-2. In the scramble for vaccination, has the importance of effective novel treatment options been overlooked? As global vaccination programs start in earnest, the identification of SARS-CoV-2 variants that may impact vaccine effectiveness has alarmed many and highlighted the fragility of our dependence on vaccination as the only way out of the current crisis. Moreover, while vaccines can stop people from contracting COVID-19 and becoming seriously ill, treatments will still be needed for those who do become infected. Effective treatments administered early in the disease course may make COVID-19 a milder disease, reduce pressure on intensive care units and reduce the number of people who go on to develop long COVID. It may also be the case that as the number of people vaccinated increases, the likelihood of the virus mutating in a manner that leads to immune escape becomes more likely.
Repurposing of established drugs
Ongoing studies, including the RECOVERY trial in the UK and the ACTIV public-private partnership in the United States, are identifying existing treatments that can be used to effectively treat COVID-19. One early outcome has been the discovery that corticosteroids, including dexamethasone and hydrocortisone, reduce mortality from COVID-19 by up to a third in critically ill patients. However, even with advances in repurposing existing therapeutics, daily death tolls and numbers of patients requiring treatment in intensive care highlight the clear unmet need for more effective treatment options.
The development of novel agents to treat viral infections
No existing therapies have been demonstrated to prevent the progression of COVID-19 to severe illness – currently COVID-19 management is limited to symptomatic and palliative treatment. Although initial results for some agents have been disappointing, the pursuit of development programs for pipeline antiviral, immunotherapy and anti-inflammatory agents, including complement inhibitors, offers hope for the future availability of drugs that make COVID-19 a much milder and more manageable disease. As coronavirus infections continue to surge around the globe, and with the inevitable emergence of new variants, continued investment in novel agents will stand us in good stead for this and future pandemics.
How the Oxford-AstraZeneca covid-19 vaccine was made. BMJ. 2021. Available from: https://www.bmj.com/content/372/bmj.n86 Covid-19: Hydrocortisone can be used as alternative to dexamethasone, review finds. BMJ. 2020. Available from: https://www.bmj.com/content/370/bmj.m3472
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