Poll: What will be the first cure for COVID-19?

The increasing number of confirmed COVID-19 cases is prompting an unprecedented global effort to find a treatment for the disease. Given the fact that a new drug development could be a decade work from initial discovery to the marketplace, scientists are racing to search a cure from a vast arsenal of existing drugs with demonstrated safety.

Among them, remdesivir from anti-viral assets is one of the most studied.  

The drug was initially developed by Gilead Sciences in 2009 to treat hepatitis C and respiratory syncytial virus and has been tested in laboratory against coronavirus such as SARS-Cov and MERS-Cov in recent years. Data from those researches have shown that remdesivir was generally safe in human and able to effectively block coronavirus from replicating, making it a potential weapon in the fight against COVID-19 pandemic caused by another coronavirus, SARS-CoV-2.  

Remdesivir was proved to be a promising drug against SARS-CoV-2.

In late June, a study published in Science confirmed that remdesivir can mimic an RNA nucleotide building block and be covalently linked to the replicating RNA, blocking further synthesis of SARS-CoV-2 RNA  (Yin Wanchao, et al., Science, 2020). Moreover, clinical benefit of remdesivir in monkeys infected with SARS-CoV-2 was also reported in June (Williamson Brandi N et al., Nature, 2020). However, what really throws the drug into the spotlight is a preliminary paper published in The New England Journal of Medicine (Beigel John H, NEJM, 2020). The researchers conducted a double-blind, randomized, placebo-controlled trial in 1063 infectors and found that remdesivir could lead to a reduction in time to recovery in COVID-19 patients. Based on the promising data, the Food and Drug Administration (FDA) issued an order for the emergency use of remdesivir on May 1. Thereafter, a total of 15 remdesivir clinical trials have been listed on the website of National Institutes of Health (NIH, 2020).


Remdesivir (Image source: Shutterstock)

Although remdesivir is the only current effective medication for COVID-19, controversy remains about the drug.

The findings from a Chinese trial suggest that remdesivir did not appear to shorten recovery time in adults with severe COVID-19 (Yeming Wang, et al., The Lancet, 2020). Some scientists also argued that even if the drug is shown to be safe and effective, it can only be given intravenously, indicating the difficulty to deploy widely and earlier in the course of the disease before the virus has caused significant damage to the body. Besides, the side effect of the drug is also a big concern. Adverse events of remdesivir, as reported by Yeming’s research team, occurred in 102 (66%) of 155 patients. In another research founded by Gilead Sciences, compassionate use of remdesivir for patients with severe COVID-19 caused in 32 (53%) recipients adverse events including diarrhea, acute kidney injury, renal impairment, etc (Jonathan Grein et al., NEJM, 2020). 

Antibody therapy is eyed as a potential substitute for antiviral.

Unlike exogenous chemical antivirals, antibodies are self-generated biological products that target a certain invader, such as SARS-CoV-2, thus they are expected to create less side effects. By deploy the right antibody from a survivor, scientists are able to turn one person’s solution to COVID-19 into a drug that can benefit others. On June 8, Eli Lilly and Company initiated a phase 1 study in China for its second antibody treatment co-developed with Junshi Biosciences (Lilly, 2020). One month later, another biological manufacturer, Regeneron, went further to start a phase 3 trial of COVID antibody cocktail to evaluate the drug's ability to prevent and treat coronavirus infection. "We are running simultaneous adaptive trials in order to move as quickly as possible to provide a potential solution to prevent and treat COVID-19 infections, even in the midst of an ongoing global pandemic," Dr. George D. Yancopoulos, co-founder, president and chief scientific officer of Regeneron, said in the company's news release (Regeneron, 2020).

Conclusion

It’s still very early to say which drug works best in COVID-19 era since scientists need time to enroll enough people in each stage to get a reliable results for different treatments.  Nevertheless, a therapy for COVID-19  is believed by most companies to be successfully manufactured in the future. The question is, which will be the first one? Antiviral drug or antibody therapy? Or is there another type of treatment you want to suggest? Take the poll below, share your opinion and receive a $20 gift card!

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For more COVID-19 posts, please visit: a summary of COVID-19 posts.

Antiviral or antibody, which will be the first cure for COVID-19?

191 participants, 2 days left

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8 Reply

I believe that antibody therapy will be the first cure, for it is not realistic to find an existing drug effectively enough (can a 90% cure rate drug make you feel safe? Maybe it should reach 99.99% that surely dose), unless a targeted drug is found or designed through further viral infection mechanisms and is clinically available. So the antibody therapy, which is regarded as a high cure rate methoed can meet the expactations of the public and eliminate thier panics.


Antibodies are mainly proteins which means there could be a reverse reaction against transferred antibodies that used as therapy. In other words although the transferred antibodies, the recipient (patient) may produce anti-anti bodies that may will be ended by the destruction the transferred antibody form donor. More clarification, the patient immune system will recognize the transferred antibodies as a forging body [(antigen (Ag)] and hens will produce anti-antibodies. However, antiviral drugs are mainly produced against the virus and they have a known destruction method. Also, most of the drugs will be chemicals that can be tolerate the patient immune system as a non-forging body (Ag) so, there will be no production of anti bodies against the viral drug.


It is not necessary to worry about anti-antibodies. As what I have read from another post on MolecularCloud, with the technology of recombinant DNA, phage display and transgenic mice, it is now possible to create completely human antibodies that are not immunogenic, thus avoiding immune reactions against foreign antibodies while enhancing the effectiveness of the treatment.

I agree with the below comment about immunity being the most promising since I do think we should focus on preventing the escalation of the disease rather than treating it when the damage is potentially irreversible. However, as vaccines take a while to develop and not everyone has a "privilege" to get exposed to the virus without risking their health (and life), I'm happy to see multiple treatment strategies being developed. I think that the more options are out there the better since not everyone responds in the same way.


Both antivirals and antibodies against coronavirus might be equally to prevent the spread of COVID-19, their effects will depend on the specificity of the treatment


I think immunity is not only more effective but also not side effects


It seems to me that there has been far less talk about antibody therapies than there has been for vaccines and anti-vitals. There has been some discussion about treatment with patient plasma, but I feel that development of an antibody drug that can be produced independent of patients holds a lot of promise.


Monoclonal antibodies are a promising approach against COVID-19.Monoclonal antibodies mimic natural antibodies.It is hoped that an antibody-based treatment could neutralise the SARS-CoV-2 virus and thus,in theory,be given as a preventative option for those exposed to the virus,as well as to treat and prevent disease progression in patients already infected by the virus.It also has the potential to provide immediate effect in the patient.The spike protein on the SARS-CoV-2 virus is the primary target being explored for potential COVID-19 mAbs.The spike protein is responsible for binding and fusing the virus to the host cell membrane.By targeting the spike protein,the antibody will be able to neutralise the effects of the SARS-CoV-2 virus by affecting its capacity to infect healthy cells.


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