1
|
So AD, Woo J, Helble M. Enabling product development partnerships to bring forward the next generation of health technologies. HEALTH AFFAIRS SCHOLAR 2024; 2:qxad088. [PMID: 38770112 PMCID: PMC11103732 DOI: 10.1093/haschl/qxad088] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/26/2023] [Revised: 09/13/2023] [Accepted: 12/21/2023] [Indexed: 05/22/2024]
Abstract
Over the past quarter century, product development partnerships (PDPs) have importantly brought health technologies, particularly for neglected diseases, to market for low- and middle-income countries (LMICs). With public sector financing, PDPs de-risk the gulf between where the global burden of disease falls and where paying markets exist. From fighting COVID-19 to developing novel antibiotics, the work of PDPs now extends beyond these traditional bounds. As PDPs have shepherded more health technologies to market, they are also confronting new access challenges. This article lays out 5 areas to strategically leverage the PDP model for better access to new health technologies. Making the case for enhanced support of the PDP approach will require greater transparency, as well as recognition of the contributions made by both public and private sector partners. The governance and funding of PDPs must be accountable to meeting the needs and building capacity of target beneficiaries in LMICs. To take an end-to-end approach, PDPs must work in tandem with other public sector institutions as well as local manufacturers as part of a larger innovation ecosystem. PDPs will need to keep pace with both the dynamics of diseases and markets in delivering the next generation of much needed health technologies.
Collapse
Affiliation(s)
- Anthony D So
- Innovation + Design Enabling Access (IDEA) Initiative, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, United States
| | - Joshua Woo
- Innovation + Design Enabling Access (IDEA) Initiative, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, United States
| | - Matthias Helble
- Research for Health Department, Science Division, World Health Organization, 1211 Geneva, Switzerland
| |
Collapse
|
2
|
Bacigalupo ML, Pignataro MF, Scopel CT, Kondratyuk S, Mellouk O, Chaves GC. Unveiling patenting strategies of therapeutics and vaccines: evergreening in the context of COVID-19 pandemic. Front Med (Lausanne) 2023; 10:1287542. [PMID: 38126073 PMCID: PMC10731306 DOI: 10.3389/fmed.2023.1287542] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2023] [Accepted: 11/09/2023] [Indexed: 12/23/2023] Open
Abstract
In the pharmaceutical sector, evergreening is considered a range of practices applied to extend monopoly protection on existing products. Filing several patent applications related to the same active pharmaceutical ingredient (API) is one of the most common manifestations of evergreening. During the COVID-19 pandemic, several health technologies were developed. This study aimed to analyze the extension of evergreening for selected health technologies for SARS-CoV-2 through patent filing strategies. Starting with the selection of three antivirals, one biological and two vaccines, a patent landscape was built based on public and private databases. Regarding these selected technologies, we analyzed some of the evergreening strategies used by different applicants, academic institutions or pharmaceutical companies and found a total of 29 applications (10 after the pandemic) for antivirals, 3 applications for a biological drug (1 after the pandemic), and 41 applications for vaccines (23 after the pandemic). Despite differences among the technologies, a common aspect found in all analyzed cases is the intense patent filing after the pandemic, aligned to the fact that those technologies were moving through the R&D process up to regulatory approval. The evergreening approach pursued has already been found in other diseases, with the risk of monopoly extension and also bringing legal uncertainty due to the lack of transparency of newer patent applications covering specific medical indications. Therefore, efforts to address evergreening should be pursued by countries, including the adoption of a public health approach to the patent examination of those technologies to prevent the granting of undeserved patents.
Collapse
Affiliation(s)
| | | | | | - Sergiy Kondratyuk
- International Treatment Preparedness Coalition Global (ITPC-Global), Bryanston, South Africa
| | - Othoman Mellouk
- International Treatment Preparedness Coalition Global (ITPC-Global), Bryanston, South Africa
| | | |
Collapse
|
3
|
Leusciatti M, Macchi B, Marino-Merlo F, Mastino A, Morra G, Quadrelli P. Inhibition of the RNA-Dependent RNA-Polymerase from SARS-CoV-2 by 6-Chloropurine Isoxazoline-Carbocyclic Monophosphate Nucleotides. ACS OMEGA 2023; 8:36311-36320. [PMID: 37810686 PMCID: PMC10552509 DOI: 10.1021/acsomega.3c04918] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/09/2023] [Accepted: 09/04/2023] [Indexed: 10/10/2023]
Abstract
Isoxazoline-carbocyclic monophosphate nucleotides were designed and synthesized through the chemistry of nitrosocarbonyl intermediates and stable anthracenenitrile oxide. Docking and molecular dynamics studies were first conducted for determining the best candidate for polymerase SARS-CoV-2 inhibition. The setup phosphorylation protocol afforded the nucleotides available for the biological tests. Preliminary inhibition and cytotoxicity assays were then performed, and the results showed a moderate activity of the nucleotides accompanied by cytotoxicity.
Collapse
Affiliation(s)
- Marco Leusciatti
- Department
of Chemistry, University of Pavia, Viale Taramelli 12, 27100 Pavia,Italy
| | - Beatrice Macchi
- Department
of Chemical Science and Technology, University
of Rome Tor Vergata, Via della ricerca scientifica 1, 00133 Roma, Italy
| | - Francesca Marino-Merlo
- Department
of Chemical, Biological, Pharmaceutical, and Environmental Sciences, University of Messina, Viale Ferdinando Stagno d’Alcontres, 31, 98166 Messina, Italy
| | - Antonio Mastino
- The
Institute of Translational Pharmacology, CNR, Via Fosso del Cavaliere 100, 00133 Roma, Italy
| | - Giulia Morra
- Biocomputing
Lab, SCITEC-Istituto di Scienze e Tecnologie
Chimiche CNR, Via Mario
Bianco 9, 20131 Milano, Italy
| | - Paolo Quadrelli
- Department
of Chemistry, University of Pavia, Viale Taramelli 12, 27100 Pavia,Italy
| |
Collapse
|
4
|
Zheng Q, Bao C, Ji Y, Li P, Ma Z, Wang X, Meng Q, Pan Q. Treating SARS-CoV-2 Omicron variant infection by molnupiravir for pandemic mitigation and living with the virus: a mathematical modeling study. Sci Rep 2023; 13:5474. [PMID: 37016035 PMCID: PMC10071263 DOI: 10.1038/s41598-023-32619-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2022] [Accepted: 03/30/2023] [Indexed: 04/06/2023] Open
Abstract
Treating severe COVID-19 patients and controlling the spread of SARS-CoV-2 are concurrently important in mitigating the pandemic. Classically, antiviral drugs are primarily developed for treating hospitalized COVID-19 patients with severe diseases to reduce morbidity and/or mortality, which have limited effects on limiting pandemic spread. In this study, we simulated the expanded applications of oral antiviral drugs such as molnupiravir to mitigate the pandemic by treating nonhospitalized COVID-19 cases. We developed a compartmental mathematical model to simulate the effects of molnupiravir treatment assuming various scenarios in the Omicron variant dominated settings in Denmark, the United Kingdom and Germany. We found that treating nonhospitalized cases can limit Omicron spread. This indirectly reduces the burden of hospitalization and patient death. The effectiveness of this approach depends on the intrinsic nature of the antiviral drug and the strategies of implementation. Hypothetically, if resuming pre-pandemic social contact pattern, extensive application of molnupiravir treatment would dramatically (but not completely) mitigate the COVID-19 burden, and thus there remains lifetime cost of living with the virus.
Collapse
Affiliation(s)
- Qinyue Zheng
- School of International Affairs and Public Administration, Ocean University of China, Qingdao, China
- School of Management, Shandong Key Laboratory of Social Supernetwork Computation and Decision Simulation, Shandong University, Jinan, China
| | - Chunbing Bao
- School of Management, Shandong Key Laboratory of Social Supernetwork Computation and Decision Simulation, Shandong University, Jinan, China
| | - Yunpeng Ji
- Department of Gastroenterology and Hepatology, Erasmus MC-University Medical Center, Rotterdam, The Netherlands
- Department of Genetics, Inner Mongolian Maternal and Child Care Hospital, Hohhot, Inner Mongolian, China
| | - Pengfei Li
- Department of Gastroenterology and Hepatology, Erasmus MC-University Medical Center, Rotterdam, The Netherlands
| | - Zhongren Ma
- Key Laboratory of Biotechnology and Bioengineering of State Ethnic Affairs Commission, Biomedical Research Center, Northwest Minzu University, Lanzhou, China
| | - Xinwei Wang
- Department of Engineering Mechanics, State Key Laboratory of Structural Analysis for Industrial, Equipment, Dalian University of Technology, Dalian, China
| | - Qingchun Meng
- School of Management, Shandong Key Laboratory of Social Supernetwork Computation and Decision Simulation, Shandong University, Jinan, China
| | - Qiuwei Pan
- Department of Gastroenterology and Hepatology, Erasmus MC-University Medical Center, Rotterdam, The Netherlands.
| |
Collapse
|
5
|
Chandler MT, Santacroce LM, Costenbader KH, Kim SC, Feldman CH. Racial differences in persistent glucocorticoid use patterns among medicaid beneficiaries with incident systemic lupus erythematosus. Semin Arthritis Rheum 2023; 58:152122. [PMID: 36372014 PMCID: PMC9976620 DOI: 10.1016/j.semarthrit.2022.152122] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2022] [Revised: 10/13/2022] [Accepted: 10/19/2022] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Glucocorticoids ("steroids") are frequently used in systemic lupus erythematosus (SLE). Prolonged use may contribute to racial/ethnic disparities in avoidable adverse outcomes. We examined racial/ethnic differences in longitudinal patterns of steroid use and dose. METHODS We identified Medicaid beneficiaries 18-65 years with incident SLE who received steroids for 12 months following the index date. Group-based trajectory modeling was used to identify patterns of daily prednisone-equivalent steroid doses. We examined demographic, clinical and healthcare utilization factors during the baseline period and used multinomial logistic regression to estimate the odds of belonging to the higher vs. lowest steroid dose trajectories over time. RESULTS We identified 6314 individuals with SLE with ≥1 dispensed steroid prescription. The mean (SD) prednisone-equivalent dose was 7 (23) mg/day for Black, 7 (26) for Hispanic, 7 (13) for Asian, and 4 (10) for White individuals. Adjusted multinomial models demonstrated higher odds of belonging to the highest vs. lowest steroid trajectory for Black (OR 2.07, 95% CI 1.65-2.61), Hispanic (OR 1.81, 95% CI 1.38-2.39), and Asian (OR 2.42, 95% CI 1.53-3.83) vs. White individuals. Having >5 outpatient visits during the baseline period was associated with lower odds of being in the persistently high-dose steroid trajectory (OR 0.77; 95% CI 0.60-0.98). CONCLUSION Black, Hispanic, and Asian (vs. White) individuals had higher odds of persistently high-dose steroid use. Sustained access to outpatient care and the development of standardized steroid-tapering regimens from clinical trials with diverse populations may be targets for intervention to mitigate disparities in steroid-related adverse outcomes.
Collapse
Affiliation(s)
- Mia T Chandler
- Division of Immunology, Boston Children's Hospital, Boston, MA, United States; Division of Rheumatology, Inflammation, and Immunity, Department of Medicine, Brigham and Women's Hospital, and Harvard Medical School, Boston, MA, United States.
| | - Leah M Santacroce
- Division of Rheumatology, Inflammation, and Immunity, Department of Medicine, Brigham and Women's Hospital, and Harvard Medical School, Boston, MA, United States
| | - Karen H Costenbader
- Division of Rheumatology, Inflammation, and Immunity, Department of Medicine, Brigham and Women's Hospital, and Harvard Medical School, Boston, MA, United States
| | - Seoyoung C Kim
- Division of Rheumatology, Inflammation, and Immunity, Department of Medicine, Brigham and Women's Hospital, and Harvard Medical School, Boston, MA, United States; Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women's Hospital, Boston, MA, United States
| | - Candace H Feldman
- Division of Rheumatology, Inflammation, and Immunity, Department of Medicine, Brigham and Women's Hospital, and Harvard Medical School, Boston, MA, United States; Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women's Hospital, Boston, MA, United States
| |
Collapse
|
6
|
Endurance of COVID 19 in wastewater, natural prescription and antiviral medication for the analysis of COVID 19 and its effects on the development of new antiseptic strategies. TOTAL ENVIRONMENT RESEARCH THEMES 2022. [PMCID: PMC9398943 DOI: 10.1016/j.totert.2022.100010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The continuous worldwide pandemic of COVID-19 brought about by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has been a public health emergency of international concern, which was formally announced by the World Health Organization (WHO). The antivirals utilized to restrict the spread of virus and the procedures for the recognition of SARS-COV-2 in wastewater has been reviewed. A main tool Wastewater-based epidemiology (WBE) played a notable role in tracking the spread of corona virus in large community. This review signifies the upgraded clinical impacts and components of Traditional Chinese Medicine (TCM), the function of various antiviral drugs against COVID 19 and the role of human covid to exist in the habitat and the viability countered; with specific spotlight on the advancement of latest strategies to assess the action of latest antiseptic-disinfectants on infections.
Collapse
|
7
|
Valenzuela-Fernández A, Cabrera-Rodriguez R, Ciuffreda L, Perez-Yanes S, Estevez-Herrera J, González-Montelongo R, Alcoba-Florez J, Trujillo-González R, García-Martínez de Artola D, Gil-Campesino H, Díez-Gil O, Lorenzo-Salazar JM, Flores C, Garcia-Luis J. Nanomaterials to combat SARS-CoV-2: Strategies to prevent, diagnose and treat COVID-19. Front Bioeng Biotechnol 2022; 10:1052436. [PMID: 36507266 PMCID: PMC9732709 DOI: 10.3389/fbioe.2022.1052436] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2022] [Accepted: 11/09/2022] [Indexed: 11/26/2022] Open
Abstract
The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection and the associated coronavirus disease 2019 (COVID-19), which severely affect the respiratory system and several organs and tissues, and may lead to death, have shown how science can respond when challenged by a global emergency, offering as a response a myriad of rapid technological developments. Development of vaccines at lightning speed is one of them. SARS-CoV-2 outbreaks have stressed healthcare systems, questioning patients care by using standard non-adapted therapies and diagnostic tools. In this scenario, nanotechnology has offered new tools, techniques and opportunities for prevention, for rapid, accurate and sensitive diagnosis and treatment of COVID-19. In this review, we focus on the nanotechnological applications and nano-based materials (i.e., personal protective equipment) to combat SARS-CoV-2 transmission, infection, organ damage and for the development of new tools for virosurveillance, diagnose and immune protection by mRNA and other nano-based vaccines. All the nano-based developed tools have allowed a historical, unprecedented, real time epidemiological surveillance and diagnosis of SARS-CoV-2 infection, at community and international levels. The nano-based technology has help to predict and detect how this Sarbecovirus is mutating and the severity of the associated COVID-19 disease, thereby assisting the administration and public health services to make decisions and measures for preparedness against the emerging variants of SARS-CoV-2 and severe or lethal COVID-19.
Collapse
Affiliation(s)
- Agustín Valenzuela-Fernández
- Laboratorio de Inmunología Celular y Viral, Unidad de Farmacología, Sección de Medicina, Facultad de Ciencias de la Salud, Universidad de La Laguna, San Cristóbal de La Laguna, Spain
| | - Romina Cabrera-Rodriguez
- Laboratorio de Inmunología Celular y Viral, Unidad de Farmacología, Sección de Medicina, Facultad de Ciencias de la Salud, Universidad de La Laguna, San Cristóbal de La Laguna, Spain
| | - Laura Ciuffreda
- Research Unit, Hospital Universitario N. S. de Candelaria, Santa Cruz de Tenerife, Spain
| | - Silvia Perez-Yanes
- Laboratorio de Inmunología Celular y Viral, Unidad de Farmacología, Sección de Medicina, Facultad de Ciencias de la Salud, Universidad de La Laguna, San Cristóbal de La Laguna, Spain
| | - Judith Estevez-Herrera
- Laboratorio de Inmunología Celular y Viral, Unidad de Farmacología, Sección de Medicina, Facultad de Ciencias de la Salud, Universidad de La Laguna, San Cristóbal de La Laguna, Spain
| | | | - Julia Alcoba-Florez
- Servicio de Microbiología, Hospital Universitario N. S. de Candelaria, Santa Cruz de Tenerife, Spain
| | - Rodrigo Trujillo-González
- Laboratorio de Inmunología Celular y Viral, Unidad de Farmacología, Sección de Medicina, Facultad de Ciencias de la Salud, Universidad de La Laguna, San Cristóbal de La Laguna, Spain
- Departamento de Análisis Matemático, Facultad de Ciencias, Universidad de La Laguna, Santa Cruz de Tenerife, Spain
| | | | - Helena Gil-Campesino
- Servicio de Microbiología, Hospital Universitario N. S. de Candelaria, Santa Cruz de Tenerife, Spain
| | - Oscar Díez-Gil
- Servicio de Microbiología, Hospital Universitario N. S. de Candelaria, Santa Cruz de Tenerife, Spain
| | - José M. Lorenzo-Salazar
- Genomics Division, Instituto Tecnológico y de Energías Renovables, Santa Cruz de Tenerife, Spain
| | - Carlos Flores
- Research Unit, Hospital Universitario N. S. de Candelaria, Santa Cruz de Tenerife, Spain
- Genomics Division, Instituto Tecnológico y de Energías Renovables, Santa Cruz de Tenerife, Spain
- CIBER de Enfermedades Respiratorias, Instituto de Salud Carlos III, Madrid, Spain
- Faculty of Health Sciences, University of Fernando Pessoa Canarias, Las Palmas de Gran Canaria, Spain
| | - Jonay Garcia-Luis
- Laboratorio de Inmunología Celular y Viral, Unidad de Farmacología, Sección de Medicina, Facultad de Ciencias de la Salud, Universidad de La Laguna, San Cristóbal de La Laguna, Spain
| |
Collapse
|
8
|
Zhu J, Li Y, Liang J, Mubareka S, Slutsky AS, Zhang H. The Potential Protective Role of GS-441524, a Metabolite of the Prodrug Remdesivir, in Vaccine Breakthrough SARS-CoV-2 Infections. INTENSIVE CARE RESEARCH 2022; 2:49-60. [PMID: 36407474 PMCID: PMC9645326 DOI: 10.1007/s44231-022-00021-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/26/2022] [Accepted: 11/01/2022] [Indexed: 06/16/2023]
Abstract
Cases of vaccine breakthrough, especially in variants of concern (VOCs) infections, are emerging in coronavirus disease (COVID-19). Due to mutations of structural proteins (SPs) (e.g., Spike proteins), increased transmissibility and risk of escaping from vaccine-induced immunity have been reported amongst the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Remdesivir was the first to be granted emergency use authorization but showed little impact on survival in patients with severe COVID-19. Remdesivir is a prodrug of the nucleoside analogue GS-441524 which is converted into the active nucleotide triphosphate to disrupt viral genome of the conserved non-structural proteins (NSPs) and thus block viral replication. GS-441524 exerts a number of pharmacological advantages over Remdesivir: (1) it needs fewer conversions for bioactivation to nucleotide triphosphate; (2) it requires only nucleoside kinase, while Remdesivir requires several hepato-renal enzymes, for bioactivation; (3) it is a smaller molecule and has a potency for aerosol and oral administration; (4) it is less toxic allowing higher pulmonary concentrations; (5) it is easier to be synthesized. The current article will focus on the discussion of interactions between GS-441524 and NSPs of VOCs to suggest potential application of GS-441524 in breakthrough SARS-CoV-2 infections. Supplementary Information The online version contains supplementary material available at 10.1007/s44231-022-00021-4.
Collapse
Affiliation(s)
- JiaYi Zhu
- Keenan Research Centre for Biomedical Science, St. Michael’s Hospital, Unity Health Toronto, Toronto, ON Canada
- Department of Physiology, University of Toronto, Toronto, ON Canada
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, ON Canada
| | - Yuchong Li
- Keenan Research Centre for Biomedical Science, St. Michael’s Hospital, Unity Health Toronto, Toronto, ON Canada
- The State Key Laboratory of Respiratory Disease, Guangzhou Institute of Respiratory Disease, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Jady Liang
- Keenan Research Centre for Biomedical Science, St. Michael’s Hospital, Unity Health Toronto, Toronto, ON Canada
- Department of Physiology, University of Toronto, Toronto, ON Canada
| | - Samira Mubareka
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, ON Canada
- Department of Medical Microbiology and Infectious Disease, Sunnybrook Health Science Centre, Toronto, ON Canada
| | - Arthur S. Slutsky
- Keenan Research Centre for Biomedical Science, St. Michael’s Hospital, Unity Health Toronto, Toronto, ON Canada
- The State Key Laboratory of Respiratory Disease, Guangzhou Institute of Respiratory Disease, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
- Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, ON Canada
| | - Haibo Zhang
- Keenan Research Centre for Biomedical Science, St. Michael’s Hospital, Unity Health Toronto, Toronto, ON Canada
- Department of Physiology, University of Toronto, Toronto, ON Canada
- The State Key Laboratory of Respiratory Disease, Guangzhou Institute of Respiratory Disease, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
- Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, ON Canada
- Department of Anaesthesiology and Pain Medicine, University of Toronto, Toronto, ON Canada
| |
Collapse
|
9
|
Guennif S. Capture and passive predation in times of COVID-19 pandemic. PUBLIC CHOICE 2022; 193:163-186. [PMID: 36248699 PMCID: PMC9547627 DOI: 10.1007/s11127-022-01005-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 02/20/2021] [Accepted: 09/10/2022] [Indexed: 06/16/2023]
Abstract
In the midst of a health crisis, a drug in development and candidate for COVID-19 contagious disease was granted orphan-drug designation (ODD). This decision by the US Food and Drug Administration was immediately denounced as an abuse of the Orphan Drug Act (ODA). This paper outlines how this decision may be considered as the result of a complex case of capture along the regulatory process. Therefore, a case study of the remdesivir episode is conducted, combining the definition of a framework for the analysis of capture and the identification of stylized facts marking the trajectory of a repositioned drug and candidate for COVID-19. In doing so, arguments are put forward to show to what extent this granting of ODD can be described as the result of a series of captures, a case of weak capture however that calls for an amendment of the ODA to preclude drugs for contagious and communicable epidemic diseases from obtaining orphan status in the first place.
Collapse
Affiliation(s)
- Samira Guennif
- Centre d’Economie de Paris Nord, Université Sorbonne Paris Nord, Villetaneuse, France
| |
Collapse
|
10
|
Repurposing production operations during COVID-19 pandemic by integrating Industry 4.0 and reconfigurable manufacturing practices: an emerging economy perspective. OPERATIONS MANAGEMENT RESEARCH 2022. [PMCID: PMC9433520 DOI: 10.1007/s12063-022-00310-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
The Covid-19 pandemic has had a significant impact on manufacturing industries and supply chains. Manufacturing industries are struggling to repurpose their production activities and ramp up the supply chain to bridge the demand–supply gap. A framework that can cover Industry 4.0 technologies and reconfigurable manufacturing system (RMS) practices is desperately needed. The current study focuses primarily on the framework that could assist managers in decision-making and the stepwise adoption of RMS during repurposing. The extensive literature review was conducted to identify the prominent Industry 4.0 technologies and RMS practices. To compute the weights of selected practices, the novel Pythagorean fuzzy analytical hierarchy process (AHP) was used; while the Pythagorean fuzzy combined compromise solution (CoCoSo) method was used to prioritize the selected performance metrics. To test the robustness of the developed framework, a sensitivity analysis was carried out. According to the findings, smart factory adoption (SFA) practices were the most significant among the major criteria, followed by reconfiguration practices (RCP), soft computing practices (SCP), sustainable & circular economy practices (SCE), and quality practices (QPS). SFA's advanced technologies and SCP's computer algorithms certainly assist in the repurposing of production activities (RPO). The results of the sensitivity analysis demonstrated the robustness of the developed framework. The developed framework will be useful during RPO, and the identified practices can make a significant contribution. Advanced technologies and sustainable practices can help to improve the organization's work culture. Managers will be able to evaluate the organization's performance with the help of identified performance metrics. The work presented here may be the first attempt to develop a framework for RPO in a pandemic situation.
Collapse
|
11
|
Zein AFMZ, Sulistiyana CS, Raffaello WM, Wibowo A, Pranata R. Sofosbuvir with daclatasvir and the outcomes of patients with COVID-19: a systematic review and meta-analysis with GRADE assessment. Postgrad Med J 2022; 98:509-514. [PMID: 37066509 PMCID: PMC8189832 DOI: 10.1136/postgradmedj-2021-140287] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2021] [Accepted: 05/21/2021] [Indexed: 12/20/2022]
Abstract
PURPOSE This systematic review and meta-analysis aimed to evaluate the effect of sofosbuvir/daclatasvir (SOF/DCV) on mortality, the need for intensive care unit (ICU) admission or invasive mechanical ventilation (IMV) and clinical recovery in patients with COVID-19. METHODS We performed a systematic literature search through the PubMed, Scopus and Embase from the inception of databases until 6 April 2021. The intervention group was SOF/DCV, and the control group was standard of care. The primary outcome was mortality, defined as clinically validated death. The secondary outcomes were (1) the need for ICU admission or IMV and (2) clinical recovery. The pooled effect estimates were reported as risk ratios (RRs). RESULTS There were four studies with a total of 231 patients in this meta-analysis. Three studies were randomised controlled trial, and one study was non-randomised. SOF/DCV was associated with lower mortality (RR: 0.31 (0.12, 0.78); p=0.013; I2: 0%) and reduced need for ICU admission or IMV (RR: 0.35 (0.18, 0.69); p=0.002; I2: 0%). Clinical recovery was achieved more frequently in the SOF/DCV (RR: 1.20 (1.04, 1.37); p=0.011; I2: 21.1%). There was a moderate certainty of evidence for mortality and need for ICU/IMV outcome, and a low certainty of evidence for clinical recovery. The absolute risk reductions were 140 fewer per 1000 for mortality and 186 fewer per 1000 for the need for ICU/IMV. The increase in clinical recovery was 146 more per 1000. CONCLUSION SOF/DCV may reduce mortality rate and need for ICU/IMV in patients with COVID-19 while increasing the chance for clinical recovery. PROTOCOL REGISTRATION PROSPERO: CRD42021247510.
Collapse
Affiliation(s)
- Ahmad Fariz Malvi Zamzam Zein
- Department of Internal Medicine, Faculty of Medicine Universitas Swadaya Gunung Jati, Cirebon, Indonesia
- Department of Internal Medicine, Waled General Hospital, Cirebon, Indonesia
| | - Catur Setiya Sulistiyana
- Department of Internal Medicine, Faculty of Medicine Universitas Swadaya Gunung Jati, Cirebon, Indonesia
- Department of Internal Medicine, Waled General Hospital, Cirebon, Indonesia
| | | | - Arief Wibowo
- Department of Cardiology and Vascular Medicine, Faculty of Medicine Universitas Padjadjaran, Rumah Sakit Umum Pusat Hasan Sadikin, Bandung, Jawa Barat, Indonesia
| | - Raymond Pranata
- Faculty of Medicine Universitas Pelita Harapan, Tangerang, Indonesia
- Department of Cardiology and Vascular Medicine, Faculty of Medicine Universitas Padjadjaran, Rumah Sakit Umum Pusat Hasan Sadikin, Bandung, Jawa Barat, Indonesia
| |
Collapse
|
12
|
Bozorgmehr R, Amiri F, Hosein Zadeh M, Ghorbani F, Khameneh Bagheri A, Yazdi E, Nekooghadam SM, Pourdowlat G, Fatemi A. Effect of Sofosbuvir on Length of Hospital Stay in Moderate COVID-19 Cases; a Randomized Controlled Trial. ARCHIVES OF ACADEMIC EMERGENCY MEDICINE 2022; 10:e46. [PMID: 35765613 PMCID: PMC9206832 DOI: 10.22037/aaem.v10i1.1621] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
INTRODUCTION Efforts to control the COVID-19 pandemic are still on. This study aimed to evaluate the effect of sofosbuvir on length of hospital stay and complications in COVID-19 cases with moderate severity. METHODS This randomized clinical trial was done on moderate COVID-19 cases, who were admitted to Shohadaye Tajrish Hospital, Tehran, Iran, from 4/2021 to 9/2021. Eligible patients were randomly allocated into two groups of intervention (sofosbuvir) and control, and their outcomes were compared regarding the length of hospital stay and complications. RESULTS 100 COVID-19 cases were randomly divided into two groups of 50 patients, as the intervention and control groups. The mean age of patients was 50.56 ± 12.23 and 57.1±14.1 years in the intervention and control groups, respectively (p = 0.02). The two groups were similar regarding distribution of gender (p = 0.15), underlying diseases (p = 0.08), the severity of COVID-19 (p = 0.80) at the time of admission, signs and symptoms (p > 0.05), and essential laboratory profile (p > 0.05). The length of hospital stay in the control and intervention groups was 7.7 ± 4.09 days and 4.7±1.6 days, respectively (p = 0.02). None of our patients needed ICU or mechanical ventilation. CONCLUSION Sofosbuvir may decrease the length of hospital stay of COVID-19 cases with moderate severity, without a significant effect on the rate of intensive care unit (ICU) need and mortality.
Collapse
Affiliation(s)
- Rama Bozorgmehr
- Clinical Research Development Unit, Shohada-e Tajrish Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Farbod Amiri
- Men’s Health and Reproductive Health Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran,Corresponding author: Farbod Amiri; Shohada-e Tajrish Hospital, Shahrdari St, Tehran, Iran. Postal Code: 19899 34148
| | - Mohammad Hosein Zadeh
- Department of internal medicine, Shohada-e Tajrish Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Fariba Ghorbani
- Tracheal Diseases Research Center, National Research Institute of Tuberculosis and Lung Diseases, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Arash Khameneh Bagheri
- Department of Radiology, Shohada-e Tajrish Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Esmat Yazdi
- Department of internal medicine, Shohada-e Tajrish Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Sayyed Mojtaba Nekooghadam
- Department of internal medicine, Shohada-e Tajrish Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Guitti Pourdowlat
- Chronic Respiratory Diseases Research Center, National Research Institute of Tuberculosis and Lung Disease (NRITLD), Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Alireza Fatemi
- Men’s Health and Reproductive Health Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| |
Collapse
|
13
|
Vegivinti CTR, Evanson KW, Lyons H, Akosman I, Barrett A, Hardy N, Kane B, Keesari PR, Pulakurthi YS, Sheffels E, Balasubramanian P, Chibbar R, Chittajallu S, Cowie K, Karon J, Siegel L, Tarchand R, Zinn C, Gupta N, Kallmes KM, Saravu K, Touchette J. Efficacy of antiviral therapies for COVID-19: a systematic review of randomized controlled trials. BMC Infect Dis 2022; 22:107. [PMID: 35100985 PMCID: PMC8802260 DOI: 10.1186/s12879-022-07068-0] [Citation(s) in RCA: 44] [Impact Index Per Article: 22.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2021] [Accepted: 01/14/2022] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Coronavirus disease 2019 (COVID-19) continues to pose a significant threat to public health worldwide. The purpose of this study was to review current evidence obtained from randomized clinical trials on the efficacy of antivirals for COVID-19 treatment. METHODS A systematic literature search was performed using PubMed to identify randomized controlled trials published up to September 4, 2021 that examined the efficacy of antivirals for COVID-19 treatment. Studies that were not randomized controlled trials or that did not include treatment of COVID-19 with approved antivirals were excluded. Risk of bias was assessed using the Scottish Intercollegiate Guidelines Network (SIGN) method. Due to study heterogeneity, inferential statistics were not performed and data were expressed as descriptive statistics. RESULTS Of the 2,284 articles retrieved, 31 (12,440 patients) articles were included. Overall, antivirals were more effective when administered early in the disease course. No antiviral treatment demonstrated efficacy at reducing COVID-19 mortality. Sofosbuvir/daclatasvir results suggested clinical improvement, although statistical power was low. Remdesivir exhibited efficacy in reducing time to recovery, but results were inconsistent across trials. CONCLUSIONS Although select antivirals have exhibited efficacy to improve clinical outcomes in COVID-19 patients, none demonstrated efficacy in reducing mortality. Larger RCTs are needed to conclusively establish efficacy.
Collapse
Affiliation(s)
- Charan Thej Reddy Vegivinti
- Department of Internal Medicine, Jacobi Medical Center, Albert Einstein College of Medicine, 1400 Pelham Pkwy S, Bronx, NY, USA
| | - Kirk W Evanson
- Superior Medical Experts, 1425 Minnehaha Ave E, P.O. Box 6000545, St Paul, MN, 55106, USA
| | - Hannah Lyons
- Nested Knowledge, 1430 Avon Street N, Saint Paul, MN, 55117, USA
- Ohio University Heritage College of Osteopathic Medicine, 6775 Bobcat Way, Dublin, OH, 43016, USA
| | - Izzet Akosman
- Nested Knowledge, 1430 Avon Street N, Saint Paul, MN, 55117, USA
- Weill Cornell Medical College, 1300 York Ave, New York, NY, 10065, USA
| | - Averi Barrett
- Nested Knowledge, 1430 Avon Street N, Saint Paul, MN, 55117, USA
| | - Nicole Hardy
- Nested Knowledge, 1430 Avon Street N, Saint Paul, MN, 55117, USA
| | - Bernadette Kane
- Superior Medical Experts, 1425 Minnehaha Ave E, P.O. Box 6000545, St Paul, MN, 55106, USA
| | - Praneeth Reddy Keesari
- Kamineni Academy of Medical Sciences and Research Center, Hyderabad, Telangana, 500068, India
| | | | - Erin Sheffels
- Superior Medical Experts, 1425 Minnehaha Ave E, P.O. Box 6000545, St Paul, MN, 55106, USA.
| | - Prasanth Balasubramanian
- Department of Internal Medicine, Jacobi Medical Center, Albert Einstein College of Medicine, 1400 Pelham Pkwy S, Bronx, NY, USA
| | - Richa Chibbar
- Department of Medicine, Lakeridge Health, 1 Hospital Crt, Oshawa, ON, L1G 2B9, Canada
| | | | - Kathryn Cowie
- Nested Knowledge, 1430 Avon Street N, Saint Paul, MN, 55117, USA
| | - J Karon
- Nested Knowledge, 1430 Avon Street N, Saint Paul, MN, 55117, USA
| | - Lauren Siegel
- Nested Knowledge, 1430 Avon Street N, Saint Paul, MN, 55117, USA
| | - Ranita Tarchand
- Nested Knowledge, 1430 Avon Street N, Saint Paul, MN, 55117, USA
| | - Caleb Zinn
- Nested Knowledge, 1430 Avon Street N, Saint Paul, MN, 55117, USA
| | - Nitin Gupta
- Department of Infectious Disease, Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Manipal, Karnataka, 576104, India
- Manipal Center for Infectious Diseases, Prasanna School of Public Health, Manipal Academy of Higher Education, Manipal, Karnataka, 576104, India
| | - Kevin M Kallmes
- Nested Knowledge, 1430 Avon Street N, Saint Paul, MN, 55117, USA
| | - Kavitha Saravu
- Department of Infectious Disease, Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Manipal, Karnataka, 576104, India
- Manipal Center for Infectious Diseases, Prasanna School of Public Health, Manipal Academy of Higher Education, Manipal, Karnataka, 576104, India
| | - Jillienne Touchette
- Superior Medical Experts, 1425 Minnehaha Ave E, P.O. Box 6000545, St Paul, MN, 55106, USA
| |
Collapse
|
14
|
Wang J, Levi J, Ellis L, Hill A. Minimum Manufacturing Costs, National Prices, and Estimated Global Availability of New Repurposed Therapies for Coronavirus Disease 2019. Open Forum Infect Dis 2022; 9:ofab581. [PMID: 34988252 PMCID: PMC8709896 DOI: 10.1093/ofid/ofab581] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2021] [Accepted: 11/17/2021] [Indexed: 12/15/2022] Open
Abstract
Background Currently, only dexamethasone, tocilizumab, and sarilumab have conclusively been shown to reduce mortality of coronavirus disease 2019 (COVID-19). Safe and effective treatments will need to be both affordable and widely available globally to be used alongside vaccination programs. This analysis will estimate and compare potential generic minimum costs of a selection of approved COVID-19 drug candidates with available international list prices. Methods We searched for repurposed drugs that have been approved by at least one of the World Health Organization, US Food and Drug Administration, or the United Kingdom National Institute of Health and Care Excellence organizations or at least given emergency use authorization or recommended for off-label prescription. Drug prices were searched for dexamethasone, budesonide, baricitinib, tocilizumab, casirivimab, and imdevimab, and sarilumab, using active pharmaceutical ingredients (APIs) data extracted from global shipping records. This was compared with national pricing data from a range of low-, medium-, and high-income countries. Annual API export volumes from India were used to estimate the current availability of each drug. Results Repurposed therapies can be generically manufactured for some treatments at very low per-course costs, ranging from US $2.58 for intravenous (IV) dexamethasone (or US $0.19 orally) and US $4.34 for inhaled budesonide. No export price data were available for baricitinib, tocilizumab, casirivimab, and imdevimab, or sarilumab, but courses of these treatments have higher prices, ranging from US $6.67 for baricitinib to US $875.5 for sarilumab. When comparing international list prices, we found wide variations between countries. Conclusions Successful management of COVID-19 will require equitable access to treatment for all populations, not just those able to pay high prices. Dexamethasone and budesonide are widely available and affordable, whereas monoclonal antibodies and IV treatment courses are more expensive.
Collapse
Affiliation(s)
- Junzheng Wang
- Faculty of Medicine, Imperial College London, London, United Kingdom
| | - Jacob Levi
- Department of Intensive Care, University College London Hospital, University College London Hospitals NHS Foundation Trust, London, United Kingdom
| | - Leah Ellis
- Faculty of Medicine, Imperial College London, London, United Kingdom
| | - Andrew Hill
- Department of Pharmacology and Therapeutics, University of Liverpool, Liverpool, United Kingdom
| |
Collapse
|
15
|
Heath K, Levi J, Hill A. The Joint United Nations Programme on HIV/AIDS 95-95-95 targets: worldwide clinical and cost benefits of generic manufacture. AIDS 2021; 35:S197-S203. [PMID: 34115649 DOI: 10.1097/qad.0000000000002983] [Citation(s) in RCA: 39] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND The Joint United Nations Programme on HIV/AIDS aims for HIV testing, treatment and viral suppression rates to be 95%--95%--95% by 2025. Patented drug prices remain a barrier to HIV treatment. Generic alternatives are being produced and exported from countries without patent barriers at a fraction of the cost. METHODS We collated export records of active pharmaceutical ingredient for HIV drugs to estimate the minimum costs of production. Using epidemiological data describing national HIV epidemics, we calculated the cost to treat 164 countries at 95%--95%-95%. Using weighted log-linear regression models, we estimated the mother-to-child transmissions (MTCTs), HIV-related deaths and new HIV infections preventable every year by increased treatment. FINDINGS We estimated that TDF/3TC/DTG could be produced for $59 per person per year. At this price, the 164 countries in our analysis could be treated at 95%--95%--95% for $2 billion a year, preventing 66 308 MTCTs, 241 811 HIV-related deaths and 631 398 new HIV infections every year. In comparison, global expenditure on HIV pharmaceuticals in 2019 was $28 billion. INTERPRETATION At $2 billion/year, the 164 countries in our analysis could be treated for the price of 4 weeks of current global sales. Global access to generic alternatives could reduce expenditure and improve clinical outcomes.
Collapse
Affiliation(s)
| | - Jacob Levi
- Accident and Emergency Medicine, Homerton Row, Clapton, London
| | - Andrew Hill
- Department of Pharmacology and Therapeutics, University of Liverpool, Liverpool, UK
| |
Collapse
|
16
|
COVID-19 in Low- and Middle-Income Countries (LMICs): A Narrative Review from Prevention to Vaccination Strategy. Vaccines (Basel) 2021; 9:vaccines9121477. [PMID: 34960223 PMCID: PMC8704834 DOI: 10.3390/vaccines9121477] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2021] [Revised: 12/03/2021] [Accepted: 12/10/2021] [Indexed: 12/18/2022] Open
Abstract
The management of the COVID-19 pandemic represents a challenging process, especially for low- and middle-income countries (LMICs) due to the serious economic and health resource problems it generates. In this article, we assess COVID-19 situation in LMICs and outline emerging problems and possible solutions. The prevention and control of COVID-19 would be based on focused tests exploiting those systems (e.g., GeneXpert®) already used in other scenarios. This would be less stressful for the healthcare system in LMICs. Avoiding close contact with people suffering from acute respiratory infections, frequent handwashing, and avoiding unprotected contact with farm or wild animals are recommended infection control interventions. The appropriate use of personal protective equipment (PPE) is required, despite its procurement being especially difficult in LMICs. Patients’ triage should be based on a simple and rapid logarithm to decide who requires isolation and targeted testing for SARS-CoV-2. Being able to estimate which patients will develop severe disease would allow hospitals to better utilize the already limited resources more effectively. In LMICs, laboratories are often in the capital cities; therefore, early diagnosis and isolation become difficult. The number of ICU beds is often insufficient, and the equipment is often old and poorly serviced. LMICs will need access to COVID-19 treatments at minimal prices to ensure that all who need them can be treated. Year-to-date, different vaccines have been approved and are currently available. The main obstacle to accessing them is the limited ability of LMICs to purchase significant quantities of the vaccine.
Collapse
|
17
|
El-Bendary M, Abd-Elsalam S, Elbaz T, El-Akel W, Cordie A, Elhadidy T, Elalfy H, Farid K, Elegezy M, El-Badrawy A, Neamatallah M, Abd Elghafar M, Salama M, AbdAllah M, Essam M, El-Shazly M, Esmat G. Efficacy of combined Sofosbuvir and Daclatasvir in the treatment of COVID-19 patients with pneumonia: a multicenter Egyptian study. Expert Rev Anti Infect Ther 2021; 20:291-295. [PMID: 34225541 DOI: 10.1080/14787210.2021.1950532] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND Limited experimental and clinical evidence suggests a potential role for sofosbuvir/daclatasvir in treating COVID19. We aim to evaluate the efficacy of generic sofosbuvir/daclatasvir in treating COVID-19 patients with pneumonia. RESEARCH DESIGN AND METHODS This multicenter prospective study involved 174 patients with COVID-19. Patients were randomized into two groups. Group A (96 patients) received sofosbuvir (400 mg)/daclatasvir (60 mg) for 14 days in combination with conventional therapy. Group B (78 patients) received conventional therapy alone. Clinical, laboratory, and radiological data were collected at baseline, after 7, 14, and 28 days of therapy. Primary endpoint was rate of clinical/virological cure. RESULTS A lower mortality rate was observed in group (A) (14% vs 21%, P = 0.07). After 1 month of therapy, no differences were found in rates of ICU admission, oxygen therapy, or ventilation. Additionally, a statistically significant shorter duration of hospital stay (9% vs 12%, P < 0.01) and a faster achievement of PCR negativity at day 14 (84% versus 47%, P < 0.01) were noticed in group (A). CONCLUSION Adding sofosbuvir/daclatasvir to conventional therapy of COVID-19 is promising. Their use is associated with shorter hospital stay, faster PCR negativity and may be reduced mortality.
Collapse
Affiliation(s)
- Mahmoud El-Bendary
- Tropical medicine and Hepatogastroenterology department, Mansoura University, Mansoura, Egypt
| | - Sherief Abd-Elsalam
- Tropical Medicine and Infectious diseases department, Tanta University, Tanta, Egypt
| | - Tamer Elbaz
- Endemic medicine department, Cairo University Hospitals, Cairo, Egypt
| | - Wafaa El-Akel
- Endemic medicine department, Cairo University Hospitals, Cairo, Egypt
| | - Ahmed Cordie
- Endemic medicine department, Cairo University Hospitals, Cairo, Egypt
| | | | - Hatem Elalfy
- Tropical medicine and Hepatogastroenterology department, Mansoura University, Mansoura, Egypt
| | - Khaled Farid
- Tropical medicine and Hepatogastroenterology department, Mansoura University, Mansoura, Egypt
| | - Mohamed Elegezy
- Tropical medicine and Hepatogastroenterology department, Mansoura University, Mansoura, Egypt
| | | | | | - Mohamed Abd Elghafar
- Anesthesia, Surgical Intensive Care and Pain Medicine Department, Tanta University, Tanta, Egypt
| | - Marwa Salama
- Tropical Medicine and Infectious diseases department, Tanta University, Tanta, Egypt
| | - Mohamed AbdAllah
- Medical Research Division, National Research Center, Giza, Egypt
| | - Mahmoud Essam
- Endemic medicine department, Cairo University Hospitals, Cairo, Egypt
| | | | - Gamal Esmat
- Endemic medicine department, Cairo University Hospitals, Cairo, Egypt
| |
Collapse
|
18
|
Lee L, Samardzic K, Wallach M, Frumkin LR, Mochly-Rosen D. Immunoglobulin Y for Potential Diagnostic and Therapeutic Applications in Infectious Diseases. Front Immunol 2021; 12:696003. [PMID: 34177963 PMCID: PMC8220206 DOI: 10.3389/fimmu.2021.696003] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2021] [Accepted: 05/26/2021] [Indexed: 01/14/2023] Open
Abstract
Antiviral, antibacterial, and antiparasitic drugs and vaccines are essential to maintaining the health of humans and animals. Yet, their production can be slow and expensive, and efficacy lost once pathogens mount resistance. Chicken immunoglobulin Y (IgY) is a highly conserved homolog of human immunoglobulin G (IgG) that has shown benefits and a favorable safety profile, primarily in animal models of human infectious diseases. IgY is fast-acting, easy to produce, and low cost. IgY antibodies can readily be generated in large quantities with minimal environmental harm or infrastructure investment by using egg-laying hens. We summarize a variety of IgY uses, focusing on their potential for the detection, prevention, and treatment of human and animal infections.
Collapse
Affiliation(s)
- Lucia Lee
- Department of Chemical and Systems Biology, Stanford University School of Medicine, Stanford, CA, United States
| | - Kate Samardzic
- Department of Chemical and Systems Biology, Stanford University School of Medicine, Stanford, CA, United States
| | - Michael Wallach
- School of Life Sciences, University of Technology, Sydney, NSW, Australia
| | | | - Daria Mochly-Rosen
- Department of Chemical and Systems Biology, Stanford University School of Medicine, Stanford, CA, United States
| |
Collapse
|
19
|
Ahmad MZ, Ahmad J, Aslam M, Khan MA, Alasmary MY, Abdel-Wahab BA. Repurposed drug against COVID-19: nanomedicine as an approach for finding new hope in old medicines. NANO EXPRESS 2021. [DOI: 10.1088/2632-959x/abffed] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Abstract
The coronavirus disease 2019 (COVID-19) has become a threat to global public health. It is caused by the novel severe acute respiratory syndrome coronavirus (SARS-CoV-2) and has triggered over 17 lakh causalities worldwide. Regrettably, no drug or vaccine has been validated for the treatment of COVID-19 and standard treatment for COVID-19 is currently unavailable. Most of the therapeutics moieties which were originally intended for the other disease are now being evaluated for the potential to be effective against COVID-19 (re-purpose). Nanomedicine has emerged as one of the most promising technologies in the field of drug delivery with the potential to deal with various diseases efficiently. It has addressed the limitations of traditional repurposed antiviral drugs including solubility and toxicity. It has also imparted enhanced potency and selectivity to antivirals towards viral cells. This review emphasizes the scope of repositioning of traditional therapeutic approaches, in addition to the fruitfulness of nanomedicine against COVID-19.
Collapse
|
20
|
Walsh K, Wallace A, Pavis M, Olszowy N, Griffin J, Hawkins N. Intellectual Property Rights and Access in Crisis. IIC; INTERNATIONAL REVIEW OF INDUSTRIAL PROPERTY AND COPYRIGHT LAW 2021; 52:379-416. [PMID: 33716312 PMCID: PMC7940865 DOI: 10.1007/s40319-021-01041-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 02/08/2021] [Indexed: 06/12/2023]
Abstract
The importance of access to intellectual property rights (IPR) protected subject-matter in two crucial areas - public health, and educational and cultural engagement - has been extensively demonstrated during the COVID-19 pandemic. Although they involve separate legal areas, patent and copyright, the common thread linking the two is intellectual property's difficult relationship with access in the public interest. This paper examines the tensions caused by access barriers, the tools used to reduce them and their effectiveness. It is clear that the access barriers magnified by COVID-19 are not restricted to narrow or specific contexts but are widespread. They are created by, and are a feature of, our existing IPR frameworks. Open movements provide limited remedies because they are not designed to, nor can adequately address the wide range of access barriers necessary to promote the public interest. Existing legislative mechanisms designed to remove access barriers similarly fail to effectively remedy access needs. These existing options are premised on the assumption that there is a singular "public" motivated by homogenous "interests", which fails to reflect the plurality and cross-border reality of the public(s) interest(s) underpinning the welfare goals of IPR. We conclude that a systemic re-evaluation is required and call for positive and equitable legal measures protective of the public(s) interest(s) to be built within IPR frameworks that also address non-IPR barriers. The current pandemic and development of a "new normal" provides a crucial opportunity to comprehensively consider the public(s) interest(s), not just during a global health crisis, but on an ongoing basis.
Collapse
Affiliation(s)
- Karen Walsh
- SCuLE Centre, University of Exeter, Exeter, UK
| | | | | | | | | | | |
Collapse
|
21
|
Bright B, Babalola CP, Sam-Agudu NA, Onyeaghala AA, Olatunji A, Aduh U, Sobande PO, Crowell TA, Tebeje YK, Phillip S, Ndembi N, Folayan MO. COVID-19 preparedness: capacity to manufacture vaccines, therapeutics and diagnostics in sub-Saharan Africa. Global Health 2021; 17:24. [PMID: 33658050 PMCID: PMC7927760 DOI: 10.1186/s12992-021-00668-6] [Citation(s) in RCA: 28] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2020] [Accepted: 02/04/2021] [Indexed: 12/15/2022] Open
Abstract
OBJECTIVE The COVID-19 pandemic is a biosecurity threat, and many resource-rich countries are stockpiling and/or making plans to secure supplies of vaccine, therapeutics, and diagnostics for their citizens. We review the products that are being investigated for the prevention, diagnosis, and treatment of COVID-19; discuss the challenges that countries in sub-Saharan Africa may face with access to COVID-19 vaccine, therapeutics, and diagnostics due to the limited capacity to manufacture them in Africa; and make recommendations on actions to mitigate these challenges and ensure health security in sub-Saharan Africa during this unprecedented pandemic and future public-health crises. MAIN BODY Sub-Saharan Africa will not be self-reliant for COVID-19 vaccines when they are developed. It can, however, take advantage of existing initiatives aimed at supporting COVID-19 vaccine access to resource-limited settings such as partnership with AstraZeneca, the Coalition for Epidemic Preparedness and Innovation, the Global Alliance for Vaccine and Immunisation, the Serum Institute of India, and the World Health Organization's COVID-19 Technology Access Pool. Accessing effective COVID-19 therapeutics will also be a major challenge for countries in sub-Saharan Africa, as production of therapeutics is frequently geared towards profitable Western markets and is ill-adapted to sub-Saharan Africa realities. The region can benefit from pooled procurement of COVID-19 therapy by the Africa Centres for Disease Control and Prevention in partnership with the African Union. If the use of convalescent plasma for the treatment of patients who are severely ill is found to be effective, access to the product will be minimally challenging since the region has a pool of recovered patients and human resources that can man supportive laboratories. The region also needs to drive the local development of rapid-test kits and other diagnostics for COVID-19. CONCLUSION Access to vaccines, therapeutics, and diagnostics for COVID-19 will be a challenge for sub-Saharan Africans. This challenge should be confronted by collaborating with vaccine developers; pooled procurement of COVID-19 therapeutics; and local development of testing and diagnostic materials. The COVID-19 pandemic should be a wake-up call for sub-Saharan Africa to build vaccines, therapeutics, and diagnostics manufacturing capacity as one of the resources needed to address public-health crises.
Collapse
Affiliation(s)
- Bisi Bright
- , COVID-19 Think Tank, Nigeria
- Live Well Initiative Academy Nigeria, Lagos, Nigeria
| | - Chinedum Peace Babalola
- , COVID-19 Think Tank, Nigeria
- Department of Pharmaceutical Chemistry, Faculty of Pharmacy, University of Ibadan, Ibadan, Nigeria
- Centre for Drug Discovery, Development & Production, University of Ibadan, Ibadan, Nigeria
- Genetics & Bioethics Unit, Institute of Advanced Medical Research & Training, College of Medicine, Ibadan, Nigeria
- College of Basic Medical Sciences, Chrisland University, Abeokuta, Ogun State, Nigeria
| | - Nadia Adjoa Sam-Agudu
- , COVID-19 Think Tank, Nigeria
- Institute of Human Virology Nigeria, Abuja, Nigeria
- Institute of Human Virology, University of Maryland School of Medicine, Baltimore, USA
- Department of Paediatrics, University of Cape Coast School of Medical Sciences, Cape Coast, Ghana
| | - Augustine Anayochukwu Onyeaghala
- , COVID-19 Think Tank, Nigeria
- Unit of Clinical Chemistry, Department of Medical Laboratory Science, University College Hospital, Ibadan, Nigeria
- Unit of Clinical Chemistry, Department of Medical Laboratory Science, Lead City University, Ibadan, Nigeria
| | - Adebola Olatunji
- , COVID-19 Think Tank, Nigeria
- Fort Worth Internal Medicine, Fort Worth, TX, USA
| | - Ufuoma Aduh
- , COVID-19 Think Tank, Nigeria
- World Health Organisation, Asaba, Delta State, Nigeria
| | - Patrick O Sobande
- , COVID-19 Think Tank, Nigeria
- Stephen's Pedi & Pulmonary Medicine, Fort Worth, TX, USA
| | - Trevor A Crowell
- U.S. Military HIV Research Program, Walter Reed Army Institute of Research, Silver Spring, MD, USA
- Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, MD, USA
| | - Yenew Kebede Tebeje
- Africa Center for Disease Control and Prevention, African Union Commission, Addis Ababa, Ethiopia
| | - Sunny Phillip
- , COVID-19 Think Tank, Nigeria
- Institute of Human Virology Nigeria, Abuja, Nigeria
| | - Nicaise Ndembi
- , COVID-19 Think Tank, Nigeria
- Institute of Human Virology Nigeria, Abuja, Nigeria
- Institute of Human Virology, University of Maryland School of Medicine, Baltimore, USA
- Africa Center for Disease Control and Prevention, African Union Commission, Addis Ababa, Ethiopia
- Kanazawa University, Graduate School of Medical Sciences, Kanazawa, Japan
| | - Morenike Oluwatoyin Folayan
- , COVID-19 Think Tank, Nigeria.
- Department of Child Dental Health, Obafemi Awolowo University, Ile-Ife, Nigeria.
| |
Collapse
|
22
|
Roozbeh F, Saeedi M, Alizadeh-Navaei R, Hedayatizadeh-Omran A, Merat S, Wentzel H, Levi J, Hill A, Shamshirian A. Sofosbuvir and daclatasvir for the treatment of COVID-19 outpatients: a double-blind, randomized controlled trial. J Antimicrob Chemother 2021; 76:753-757. [PMID: 33338232 PMCID: PMC7798988 DOI: 10.1093/jac/dkaa501] [Citation(s) in RCA: 41] [Impact Index Per Article: 13.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2020] [Accepted: 11/09/2020] [Indexed: 02/06/2023] Open
Abstract
INTRODUCTION Effective treatments are urgently needed to tackle the novel coronavirus disease 2019 (COVID-19). This trial aims to evaluate sofosbuvir and daclatasvir versus standard care for outpatients with mild COVID-19 infection. METHODS This was a randomized controlled clinical trial in outpatients with mild COVID-19. Patients were randomized into a treatment arm receiving sofosbuvir/daclatasvir plus hydroxychloroquine or a control arm receiving hydroxychloroquine alone. The primary endpoint of the trial was symptom alleviation after 7 days of follow-up. The secondary endpoint of the trial was hospital admission. Fatigue, dyspnoea and loss of appetite were investigated after 1 month of follow-up. This study is registered with the IRCT.ir under registration number IRCT20200403046926N1. RESULTS Between 8 April 2020 and 19 May 2020, 55 patients were recruited and allocated to either the sofosbuvir/daclatasvir treatment arm (n = 27) or the control arm (n = 28). Baseline characteristics were similar across treatment arms. There was no significant difference in symptoms at Day 7. One patient was admitted to hospital in the sofosbuvir/daclatasvir arm and four in the control arm, but the difference was not significant. After 1 month of follow-up, two patients reported fatigue in the sofosbuvir/daclatasvir arm and 16 in the control arm; P < 0.001. CONCLUSIONS In this study, sofosbuvir/daclatasvir did not significantly alleviate symptoms after 7 days of treatment compared with control. Although fewer hospitalizations were observed in the sofosbuvir/daclatasvir arm, this was not statistically significant. Sofosbuvir/daclatasvir significantly reduced the number of patients with fatigue and dyspnoea after 1 month. Larger, well-designed trials are warranted.
Collapse
Affiliation(s)
| | - Majid Saeedi
- Pharmaceutical Sciences Research Center, Mazandaran University of Medical Sciences, Sari, Iran
| | - Reza Alizadeh-Navaei
- Gastrointestinal Cancer Research Center, Non-Communicable Diseases Institute, Mazandaran University of Medical Sciences, Sari, Iran
| | - Akbar Hedayatizadeh-Omran
- Gastrointestinal Cancer Research Center, Non-Communicable Diseases Institute, Mazandaran University of Medical Sciences, Sari, Iran
| | - Shahin Merat
- Liver and Pancreatobiliary Diseases Research Center, Digestive Disease Research Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Hannah Wentzel
- School of Public Health, Imperial College London, London, UK
| | - Jacob Levi
- Department of Emergency Medicine, Homerton University Hospital, London, UK
| | - Andrew Hill
- Department of Pharmacology and Therapeutics, University of Liverpool, Liverpool, UK
| | - Amir Shamshirian
- Gastrointestinal Cancer Research Center, Non-Communicable Diseases Institute, Mazandaran University of Medical Sciences, Sari, Iran
- Department of Medical Laboratory Sciences, School of Allied Medical Science, Mazandaran University of Medical Sciences, Sari, Iran
| |
Collapse
|
23
|
Socal MP, Anderson GF. The Role of Advance Purchasing Commitments in Government Drug Price Negotiations: Lessons From the COVID-19 Response. Am J Public Health 2021; 111:652-657. [PMID: 33507827 DOI: 10.2105/ajph.2020.306109] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Affiliation(s)
- Mariana P Socal
- Mariana P. Socal and Gerard F. Anderson are with the Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Gerard F Anderson
- Mariana P. Socal and Gerard F. Anderson are with the Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| |
Collapse
|
24
|
Simmons B, Wentzel H, Mobarak S, Eslami G, Sadeghi A, Ali Asgari A, Abbaspour Kasgari H, Tirgar Fakheri H, Merat S, Hill A. Sofosbuvir/daclatasvir regimens for the treatment of COVID-19: an individual patient data meta-analysis. J Antimicrob Chemother 2021; 76:286-291. [PMID: 33063117 PMCID: PMC7665526 DOI: 10.1093/jac/dkaa418] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2020] [Accepted: 09/13/2020] [Indexed: 01/20/2023] Open
Abstract
BACKGROUND The combination of sofosbuvir and daclatasvir has a well-established safety profile and improves clinical outcomes in HCV patients. In silico and in vitro studies suggest that sofosbuvir/daclatasvir may show antiviral activity against SARS-CoV-2. METHODS Three clinical trials comparing sofosbuvir/daclatasvir-based regimens with a comparator in hospitalized COVID-19 patients were combined in a meta-analysis. The primary outcomes measured were clinical recovery within 14 days of randomization, time to clinical recovery and all-cause mortality. A two-step approach was used to analyse individual-level patient data. The individual trial statistics were pooled using the random-effects inverse-variance model. RESULTS Our search identified eight studies of which three met the inclusion criteria (n = 176 patients); two studies were randomized and one was non-randomized. Baseline characteristics were similar across treatment arms. Clinical recovery within 14 days of randomization was higher in the sofosbuvir/daclatasvir arms compared with control arms [risk ratio = 1.34 (95% CI = 1.05-1.71), P = 0.020]. Sofosbuvir/daclatasvir improves time to clinical recovery [HR = 2.04 (95% CI = 1.25-3.32), P = 0.004]. The pooled risk of all-cause mortality was significantly lower in the sofosbuvir/daclatasvir arms compared with control arms [risk ratio = 0.31 (95% CI = 0.12-0.78), P = 0.013]. CONCLUSIONS Available evidence suggests that sofosbuvir/daclatasvir improves survival and clinical recovery in patients with moderate to severe COVID-19. However, the sample size for analysis was relatively small, one of the trials was not randomized and the designs were not standardized. These results need to be confirmed in larger randomized controlled trials.
Collapse
Affiliation(s)
- Bryony Simmons
- Department of Infectious Diseases, Imperial College London, London, UK
| | - Hannah Wentzel
- School of Public Health, Imperial College London, London, UK
| | - Sara Mobarak
- Abadan Faculty of Medical Sciences, Abadan, Iran
| | | | - Anahita Sadeghi
- Digestive Disease Research Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Ali Ali Asgari
- Digestive Disease Research Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Hamideh Abbaspour Kasgari
- Department of Clinical Pharmacy, School of Pharmacy, Mazandaran University of Medical Sciences, Sari, Iran
| | - Hafez Tirgar Fakheri
- Gut and Liver Research Centre, Mazandaran University of Medical Sciences, Sari, Iran
| | - Shahin Merat
- Digestive Disease Research Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Andrew Hill
- Department of Translational Medicine, University of Liverpool, UK
| |
Collapse
|
25
|
Flynn MB, Silva EO. Framing access to medicines during COVID-19: A qualitative content analysis of Gilead's Remdesivir. Glob Public Health 2021; 16:1499-1511. [PMID: 33460356 DOI: 10.1080/17441692.2020.1871498] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
The COVID-19 pandemic calls into question the institutional structure underlying the pharmaceutical industry. While some have called for medical technologies to be global public goods and patent waivers on pharmaceuticals, much of the industry has pushed back against any attempts that might threaten their monopoly power to set prices. Public acceptance of the role of private companies to control life-saving drugs, as well as of the intellectual property system, informs campaigns guaranteeing universal access to medicines and corporate strategies to shape policy. This study consists of a qualitative content analysis of online comments about news reports of Gilead Science's pricing of remdesivir, a re-purposed drug that shows some positive efficacy against COVID-19 in clinical trials. Analysing elite and public framing about medicine pricing informs our understanding of the social construction of markets. The findings identify hegemonic and counter-hegemonic discourse about innovation, affordability, saving lives, health care savings and international comparisons that stimulate debate and potentially advocacy. As such, the discursive context delineates the possibilities for remediating the normative and material structure of a pharmaceutical system currently geared towards private profit instead of public health needs.
Collapse
Affiliation(s)
- Matthew B Flynn
- The Department of Political Science and International Studies and the Department of Sociology and Anthropology, Georgia Southern University, Statesboro, GA, USA
| | - Eric O Silva
- The Department of Political Science and International Studies and the Department of Sociology and Anthropology, Georgia Southern University, Statesboro, GA, USA
| |
Collapse
|
26
|
Fiolet T, Guihur A, Rebeaud ME, Mulot M, Peiffer-Smadja N, Mahamat-Saleh Y. Effect of hydroxychloroquine with or without azithromycin on the mortality of coronavirus disease 2019 (COVID-19) patients: a systematic review and meta-analysis. Clin Microbiol Infect 2021; 27:19-27. [PMID: 32860962 PMCID: PMC7449662 DOI: 10.1016/j.cmi.2020.08.022] [Citation(s) in RCA: 190] [Impact Index Per Article: 63.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2020] [Revised: 08/10/2020] [Accepted: 08/15/2020] [Indexed: 02/07/2023]
Abstract
BACKGROUND Hydroxychloroquine or chloroquine with or without azithromycin have been widely promoted to treat coronavirus disease 2019 (COVID-19) following early in vitro antiviral effects against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). OBJECTIVE The aim of this systematic review and meta-analysis was to assess whether chloroquine or hydroxychloroquine with or without azithromycin decreased COVID-19 mortality compared with the standard of care. DATA SOURCES PubMed, Web of Science, Embase Cochrane Library, Google Scholar and MedRxiv were searched up to 25 July 2020. STUDY ELIGIBILITY CRITERIA We included published and unpublished studies comparing the mortality rate between patients treated with chloroquine or hydroxychloroquine with or without azithromycin and patients managed with standard of care. PARTICIPANTS Patients ≥18 years old with confirmed COVID-19. INTERVENTIONS Chloroquine or hydroxychloroquine with or without azithromycin. METHODS Effect sizes were pooled using a random-effects model. Multiple subgroup analyses were conducted to assess drug safety. RESULTS The initial search yielded 839 articles, of which 29 met our inclusion criteria. All studies except one were conducted on hospitalized patients and evaluated the effects of hydroxychloroquine with or without azithromycin. Among the 29 articles, three were randomized controlled trials, one was a non-randomized trial and 25 were observational studies, including 11 with a critical risk of bias and 14 with a serious or moderate risk of bias. After excluding studies with critical risk of bias, the meta-analysis included 11 932 participants for the hydroxychloroquine group, 8081 for the hydroxychloroquine with azithromycin group and 12 930 for the control group. Hydroxychloroquine was not significantly associated with mortality: pooled relative risk (RR) 0.83 (95% CI 0.65-1.06, n = 17 studies) for all studies and RR = 1.09 (95% CI 0.97-1.24, n = 3 studies) for randomized controlled trials. Hydroxychloroquine with azithromycin was associated with an increased mortality (RR = 1.27; 95% CI 1.04-1.54, n = 7 studies). We found similar results with a Bayesian meta-analysis. CONCLUSION Hydroxychloroquine alone was not associated with reduced mortality in hospitalized COVID-19 patients but the combination of hydroxychloroquine and azithromycin significantly increased mortality.
Collapse
Affiliation(s)
- Thibault Fiolet
- CESP (Centre for Research in Epidemiology and Population Health), Faculté de Médecine-Université Paris-Sud, Faculté de Médecine-UVSQ, INSERM, Université Paris Saclay, Villejuif, France; Gustave Roussy, Villejuif, France.
| | - Anthony Guihur
- Department of Plant Molecular Biology, Faculty of Biology and Medicine, University of Lausanne, Switzerland
| | - Mathieu Edouard Rebeaud
- Department of Plant Molecular Biology, Faculty of Biology and Medicine, University of Lausanne, Switzerland
| | - Matthieu Mulot
- Laboratory of Soil Biodiversity, Faculty of Science, University of Neuchâtel, Switzerland
| | - Nathan Peiffer-Smadja
- Université de Paris, IAME, INSERM, Paris, France; National Institute for Health Research Health Protection Research Unit in Healthcare Associated Infections and Antimicrobial Resistance, Imperial College, London, UK; Infectious and Tropical Diseases Department, Bichat-Claude Bernard Hospital, AP-HP, Paris, France
| | - Yahya Mahamat-Saleh
- CESP (Centre for Research in Epidemiology and Population Health), Faculté de Médecine-Université Paris-Sud, Faculté de Médecine-UVSQ, INSERM, Université Paris Saclay, Villejuif, France; Gustave Roussy, Villejuif, France
| |
Collapse
|
27
|
Kapczynski A. Realizing Public Rights Through Government Patent Use. THE JOURNAL OF LAW, MEDICINE & ETHICS : A JOURNAL OF THE AMERICAN SOCIETY OF LAW, MEDICINE & ETHICS 2021; 49:34-38. [PMID: 33966648 DOI: 10.1017/jme.2021.7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
A substantial portion of biomedical R&D is publicly funded. But resulting medicines are typically covered by patents held by private firms, and priced without regard to the public's investment. The Bayh-Dole Act provides a possible remedy, but its scope is limited.
Collapse
|
28
|
Laws M, Surani YM, Hasan MM, Chen Y, Jin P, Al-Adhami T, Chowdhury M, Imran A, Psaltis I, Jamshidi S, Nahar KS, Rahman KM. Current Trends and Future Approaches in Small-Molecule Therapeutics for COVID-19. Curr Med Chem 2021; 28:3803-3824. [PMID: 32693756 PMCID: PMC7611096 DOI: 10.2174/0929867327666200721161840] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2020] [Revised: 06/29/2020] [Accepted: 06/30/2020] [Indexed: 02/06/2023]
Abstract
The novel coronavirus (SARS-CoV-2) pandemic has created a global public health emergency. The pandemic is causing substantial morbidity, mortality and significant economic loss. Currently, no approved treatments for COVID-19 are available, and it is likely to takes at least 12-18 months to develop a new vaccine. Therefore, there is an urgent need to find new therapeutics that can be progressed to clinical development as soon as possible. Repurposing regulatory agency-approved drugs and experimental drugs with known safety profiles can provide important repositories of compounds that can be fast-tracked to clinical development. Globally, over 500 clinical trials involving repurposed drugs have been registered, and over 150 have been initiated, including some backed by the World Health Organisation (WHO). This review is intended as a guide to research into small-molecule therapies to treat COVID-19; it discusses the SARS-CoV-2 infection cycle and identifies promising viral therapeutic targets, reports on a number of promising pre-approved small-molecule drugs with reference to over 150 clinical trials worldwide, and offers a perspective on the future of the field.
Collapse
Affiliation(s)
- Mark Laws
- Institute of Pharmaceutical Sciences, School of Cancer and Pharmaceutical Sciences, King’s College London, Franklin-Wilkins Building, 150 Stamford Street, London, SE1 9NH, UK
| | - Yasmin M. Surani
- Institute of Pharmaceutical Sciences, School of Cancer and Pharmaceutical Sciences, King’s College London, Franklin-Wilkins Building, 150 Stamford Street, London, SE1 9NH, UK
| | - Md. Mahbub Hasan
- Institute of Pharmaceutical Sciences, School of Cancer and Pharmaceutical Sciences, King’s College London, Franklin-Wilkins Building, 150 Stamford Street, London, SE1 9NH, UK
| | - Yiyuan Chen
- Institute of Pharmaceutical Sciences, School of Cancer and Pharmaceutical Sciences, King’s College London, Franklin-Wilkins Building, 150 Stamford Street, London, SE1 9NH, UK
| | - Peiqin Jin
- Institute of Pharmaceutical Sciences, School of Cancer and Pharmaceutical Sciences, King’s College London, Franklin-Wilkins Building, 150 Stamford Street, London, SE1 9NH, UK
| | - Taha Al-Adhami
- Institute of Pharmaceutical Sciences, School of Cancer and Pharmaceutical Sciences, King’s College London, Franklin-Wilkins Building, 150 Stamford Street, London, SE1 9NH, UK
| | - Madiha Chowdhury
- Institute of Pharmaceutical Sciences, School of Cancer and Pharmaceutical Sciences, King’s College London, Franklin-Wilkins Building, 150 Stamford Street, London, SE1 9NH, UK
| | - Aqeel Imran
- Institute of Pharmaceutical Sciences, School of Cancer and Pharmaceutical Sciences, King’s College London, Franklin-Wilkins Building, 150 Stamford Street, London, SE1 9NH, UK
| | - Ioannis Psaltis
- Institute of Pharmaceutical Sciences, School of Cancer and Pharmaceutical Sciences, King’s College London, Franklin-Wilkins Building, 150 Stamford Street, London, SE1 9NH, UK
| | - Shirin Jamshidi
- Institute of Pharmaceutical Sciences, School of Cancer and Pharmaceutical Sciences, King’s College London, Franklin-Wilkins Building, 150 Stamford Street, London, SE1 9NH, UK
| | - Kazi S. Nahar
- Institute of Pharmaceutical Sciences, School of Cancer and Pharmaceutical Sciences, King’s College London, Franklin-Wilkins Building, 150 Stamford Street, London, SE1 9NH, UK
| | - Khondaker Miraz Rahman
- Institute of Pharmaceutical Sciences, School of Cancer and Pharmaceutical Sciences, King’s College London, Franklin-Wilkins Building, 150 Stamford Street, London, SE1 9NH, UK
| |
Collapse
|
29
|
Nejadghaderi SA, Nazemalhosseini-Mojarad E, Asadzadeh Aghdaei H. Fecal microbiota transplantation for COVID-19; a potential emerging treatment strategy. Med Hypotheses 2020; 147:110476. [PMID: 33482620 PMCID: PMC7774521 DOI: 10.1016/j.mehy.2020.110476] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2020] [Revised: 11/05/2020] [Accepted: 12/26/2020] [Indexed: 02/06/2023]
Abstract
At the end of 2019, an emerging outbreak caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) that first reported from Wuhan, China. The first manifestations of patients infected with SARS-CoV-2 was flu-like symptoms, while other type of manifestations, especially gastrointestinal manifestations were discovered recently. As of June 2020, there is no specific drug or treatment strategy for COVID-19, a disease caused by SARS-CoV-2, so different combination of antiviral drugs is currently being used. Gut microbiota mostly consists of four phyla, including Firmicutes, Bacteroidetes, Proteobacteria, and Actinobacteria. The interaction between gut microbiota and immune system through releasing some cytokines such as IL-1β, IL-2, IL-10, TNF-α, and IFN-γ that play roles in the severity of COVID-19. In this article, a new potential treatment for COVID-19 by fecal microbiota transplantation (FMT) is described. FMT revealed promising results in different diseases, especially recurrent clostridium difficile infection, and it might reduce length of hospital admission and severity of the disease by modification of gut microbiota composition.
Collapse
Affiliation(s)
- Seyed Aria Nejadghaderi
- School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran; Systematic Review and Meta-analysis Expert Group (SRMEG), Universal Scientific Education and Research Network (USERN), Tehran, Iran
| | - Ehsan Nazemalhosseini-Mojarad
- Gastroenterology & Liver Diseases Research Center, Research Institute for Gastroenterology & Liver Diseases, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Hamid Asadzadeh Aghdaei
- Basic & Molecular Epidemiology of Gastrointestinal Disorders Research Center, Research Institute for Gastroenterology & Liver Diseases, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
| |
Collapse
|
30
|
Sali S, Shabani S, Tavakolpour S. Sofosbuvir for the Treatment of COVID-19 Patients: Is It a Promising Therapeutic Medicine for the Inhibition of Severe Acute Respiratory Syndrome Coronavirus 2? AVICENNA JOURNAL OF MEDICAL BIOCHEMISTRY 2020. [DOI: 10.34172/ajmb.2020.19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Affiliation(s)
- Shahnaz Sali
- Infectious Diseases and Tropical Medicine Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Shiva Shabani
- Infectious Diseases and Tropical Medicine Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Soheil Tavakolpour
- Infectious Diseases and Tropical Medicine Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| |
Collapse
|
31
|
Nhamo G, Chikodzi D, Kunene HP, Mashula N. COVID-19 vaccines and treatments nationalism: Challenges for low-income countries and the attainment of the SDGs. Glob Public Health 2020; 16:319-339. [DOI: 10.1080/17441692.2020.1860249] [Citation(s) in RCA: 43] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Affiliation(s)
- Godwell Nhamo
- Exxaro Chair in Business and Climate Change, Institute for Corporate Citizenship, Unisa, South Africa
| | - David Chikodzi
- Exxaro Chair in Business and Climate Change, Institute for Corporate Citizenship, Unisa, South Africa
| | - Hlengiwe Precious Kunene
- Junior Researcher: Exxaro Chair in Business and Climate Change, Institute for Corporate Citizenship, Unisa, South Africa
| | - Nthivhiseni Mashula
- Junior Researcher: Exxaro Chair in Business and Climate Change, Institute for Corporate Citizenship, Unisa, South Africa
| |
Collapse
|
32
|
Lexchin J. Are academia-pharma partnerships essential for novel drug discovery in the time of the COVID-19 pandemic? Expert Opin Drug Discov 2020; 16:475-479. [PMID: 33307875 DOI: 10.1080/17460441.2021.1858794] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Affiliation(s)
- Joel Lexchin
- Professor Emeritus, School of Health Policy and Management, York University, Toronto, ON, Canada.,Associate Professor, Department of Family and Community Medicine, University of Toronto, Toronto, ON, Canada.,Emergency Physician, University Health Network, Toronto, ON, Canada
| |
Collapse
|
33
|
McMahon A. Global equitable access to vaccines, medicines and diagnostics for COVID-19: The role of patents as private governance. JOURNAL OF MEDICAL ETHICS 2020; 47:medethics-2020-106795. [PMID: 33257522 PMCID: PMC7705422 DOI: 10.1136/medethics-2020-106795] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/12/2020] [Revised: 10/12/2020] [Accepted: 10/13/2020] [Indexed: 05/14/2023]
Abstract
In June 2020, Gilead agreed to provide the USA with 500 000 doses of remdesivir-an antiviral drug which at that time was percieved to show promise in reducing the recovery time for patients with COVID-19. This quantity represented Gilead's then full production capacity for July and 90% of its capacity for August and September. Similar deals are evident around access to proposed vaccines for COVID-19, and such deals are only likely to increase. These attempts to secure preferential access to medicines and vaccines, so-called vaccine/treatment nationalism, jeopardise supplies of life-saving treatments and vaccines available elsewhere, and jeopardise global equitable distribution of such vaccines/treatments more generally. Much of the focus to date has been on States' role in negotiating such deals. However, such developments also demonstrate the power patent holders have in controlling access to life-saving healthcare, determining who obtains access first and at what price. This article argues that the extent of control currently given to patent holders for COVID-19 must be questioned. This article demonstrates that patents have significant implications for healthcare acting as private governance tools over patented inventions. It is only by greater probing of patent holders' role in delivering access to medicines, diagnostics and vaccines for COVID-19 that equitable global equitable access can be achieved.
Collapse
Affiliation(s)
- Aisling McMahon
- Department of Law, National University of Ireland Maynooth, Maynooth, Kildare, Ireland
| |
Collapse
|
34
|
Abbaspour Kasgari H, Moradi S, Shabani AM, Babamahmoodi F, Davoudi Badabi AR, Davoudi L, Alikhani A, Hedayatizadeh Omran A, Saeedi M, Merat S, Wentzel H, Garratt A, Levi J, Simmons B, Hill A, Tirgar Fakheri H. Evaluation of the efficacy of sofosbuvir plus daclatasvir in combination with ribavirin for hospitalized COVID-19 patients with moderate disease compared with standard care: a single-centre, randomized controlled trial. J Antimicrob Chemother 2020; 75:3373-3378. [PMID: 32812025 PMCID: PMC7454669 DOI: 10.1093/jac/dkaa332] [Citation(s) in RCA: 60] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2020] [Accepted: 07/03/2020] [Indexed: 01/11/2023] Open
Abstract
BACKGROUND New therapeutic options are urgently needed to tackle the novel coronavirus disease 2019 (COVID-19). Repurposing existing pharmaceuticals provides an immediate treatment opportunity. We assessed the efficacy of sofosbuvir and daclatasvir with ribavirin for treating patients with COVID-19. METHODS This was a single-centre, randomized controlled trial in adults with moderate COVID-19 admitted to the Ghaem Shahr Razi Hospital in Mazandaran Province, Iran. Patients were randomly assigned to 400 mg sofosbuvir, 60 mg daclatasvir and 1200 mg ribavirin (intervention group) or to standard care (control group). The primary endpoint of this study was length of hospital stay. This study is registered by IRCT.ir under the ID: IRCT20200328046886N1. RESULTS Between 20 March 2020 and 8 April 2020, 48 patients were recruited; 24 patients were randomly assigned to the intervention group and 24 to the control group. The median duration of hospital stay was 6 days in both groups (P = 0.398). The number of ICU admissions in the sofosbuvir/daclatasvir/ribavirin group was not significantly lower than the control group (0 versus 4, P = 0.109). There was no difference in the number of deaths between the groups (0 versus 3, P = 0.234). The cumulative incidence of recovery was higher in the sofosbuvir/daclatasvir/ribavirin arm (Gray's P = 0.033). CONCLUSIONS This randomized trial was too small to make definitive conclusions. There were trends in favour of the sofosbuvir/daclatasvir/ribavirin arm for recovery and lower death rates. However, there was an imbalance in the baseline characteristics between the arms. Larger randomized trials should be conducted to investigate this treatment further.
Collapse
Affiliation(s)
- Hamideh Abbaspour Kasgari
- Department of Clinical Pharmacy, School of Pharmacy, Mazandaran University of Medical Sciences, Sari, Iran
| | - Siavash Moradi
- Education Development Center, Mazandaran University of Medical Sciences, Sari, Iran
| | - Amir Mohammad Shabani
- Department of Clinical Pharmacy, School of Pharmacy, Mazandaran University of Medical Sciences, Sari, Iran
| | - Farhang Babamahmoodi
- Antimicrobial Resistance Research Center, Mazandaran University of Medical Sciences, Sari, Iran
| | - Ali Reza Davoudi Badabi
- Antimicrobial Resistance Research Center, Mazandaran University of Medical Sciences, Sari, Iran
| | - Lotfollah Davoudi
- Antimicrobial Resistance Research Center, Mazandaran University of Medical Sciences, Sari, Iran
| | - Ahmad Alikhani
- Antimicrobial Resistance Research Center, Mazandaran University of Medical Sciences, Sari, Iran
| | - Akbar Hedayatizadeh Omran
- Gastrointestinal Cancer Research Center, Cancer Research Institute, Mazandaran University of Medical Sciences, Sari, Iran
| | - Majid Saeedi
- Pharmaceutical Sciences Research Center, Hemoglobinopathy Research Institute, Mazandaran University of Medical Sciences, Sari, Iran
| | - Shahin Merat
- Liver and Pancreatobiliary Diseases Research Center, Digestive Disease Research Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Hannah Wentzel
- School of Public Health, Imperial College London, London, UK
| | - Anna Garratt
- Cardiff and Vale University Health Board, Cardiff, UK
| | - Jacob Levi
- Accident and Emergency Department, Homerton University Hospital NHS Trust, London, UK
| | - Bryony Simmons
- Department of Infectious Disease, Imperial College London, London, UK
| | - Andrew Hill
- Department of Translational Medicine, University of Liverpool, UK
| | - Hafez Tirgar Fakheri
- Gut and Liver Research Center, Mazandaran University of Medical Sciences, Sari, Iran
| |
Collapse
|
35
|
Sadeghi A, Ali Asgari A, Norouzi A, Kheiri Z, Anushirvani A, Montazeri M, Hosamirudsai H, Afhami S, Akbarpour E, Aliannejad R, Radmard AR, Davarpanah AH, Levi J, Wentzel H, Qavi A, Garratt A, Simmons B, Hill A, Merat S. Sofosbuvir and daclatasvir compared with standard of care in the treatment of patients admitted to hospital with moderate or severe coronavirus infection (COVID-19): a randomized controlled trial. J Antimicrob Chemother 2020; 75:3379-3385. [PMID: 32812039 PMCID: PMC7454592 DOI: 10.1093/jac/dkaa334] [Citation(s) in RCA: 76] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2020] [Accepted: 07/03/2020] [Indexed: 02/07/2023] Open
Abstract
Background Currently no effective antiviral therapy has been found to treat COVID-19. The aim of this trial was to assess if the addition of sofosbuvir and daclatasvir improved clinical outcomes in patients with moderate or severe COVID-19. Methods This was an open-label, multicentre, randomized controlled clinical trial in adults with moderate or severe COVID-19 admitted to four university hospitals in Iran. Patients were randomized into a treatment arm receiving sofosbuvir and daclatasvir plus standard care, or a control arm receiving standard care alone. The primary endpoint was clinical recovery within 14 days of treatment. The study is registered with IRCT.ir under registration number IRCT20200128046294N2. Results Between 26 March and 26 April 2020, 66 patients were recruited and allocated to either the treatment arm (n = 33) or the control arm (n = 33). Clinical recovery within 14 days was achieved by 29/33 (88%) in the treatment arm and 22/33 (67%) in the control arm (P = 0.076). The treatment arm had a significantly shorter median duration of hospitalization [6 days (IQR 4–8)] than the control group [8 days (IQR 5–13)]; P = 0.029. Cumulative incidence of hospital discharge was significantly higher in the treatment arm versus the control (Gray’s P = 0.041). Three patients died in the treatment arm and five in the control arm. No serious adverse events were reported. Conclusions The addition of sofosbuvir and daclatasvir to standard care significantly reduced the duration of hospital stay compared with standard care alone. Although fewer deaths were observed in the treatment arm, this was not statistically significant. Conducting larger scale trials seems prudent.
Collapse
Affiliation(s)
- Anahita Sadeghi
- Liver and Pancreatobiliary Diseases Research Center, Digestive Disease Research Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Ali Ali Asgari
- Liver and Pancreatobiliary Diseases Research Center, Digestive Disease Research Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Alireza Norouzi
- Golestan Research Center of Gastroenterology and Hepatology, Golestan University of Medical Science, Gorgan, Iran
| | - Zahedin Kheiri
- Department of Internal Medicine, Baharloo hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Amir Anushirvani
- Liver and Pancreatobiliary Diseases Research Center, Digestive Disease Research Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Mahnaz Montazeri
- Department of infectious diseases, Sina Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Hadiseh Hosamirudsai
- Department of Infectious Diseases, Baharloo Hospital, Tehran University of Medical Science, Tehran, Iran
| | - Shirin Afhami
- Department of infectious diseases, Shariati Hospital, Tehran University of Medical Science, Tehran, Iran
| | - Elham Akbarpour
- Liver and Pancreatobiliary Diseases Research Center, Digestive Disease Research Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Rasoul Aliannejad
- Department of Pulmonary and Critical Care, Shariati Hospital, Thoracic Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Amir Reza Radmard
- Department of Radiology, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Amir H Davarpanah
- Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, GA, USA
| | - Jacob Levi
- Department of Emergency Medicine, Homerton University Hospital, London, UK
| | - Hannah Wentzel
- School of Public Health, Imperial College London, London, UK
| | - Ambar Qavi
- School of Public Health, Imperial College London, London, UK
| | - Anna Garratt
- Cardiff and Vale University Health Board, Cardiff, UK
| | - Bryony Simmons
- Department of Infectious Disease, Imperial College London, London, UK
| | - Andrew Hill
- Department of Pharmacology and Therapeutics, University of Liverpool, Liverpool, UK
| | - Shahin Merat
- Liver and Pancreatobiliary Diseases Research Center, Digestive Disease Research Institute, Tehran University of Medical Sciences, Tehran, Iran
| |
Collapse
|
36
|
Golchin A. Cell-Based Therapy for Severe COVID-19 Patients: Clinical Trials and Cost-Utility. Stem Cell Rev Rep 2020; 17:56-62. [PMID: 33009982 PMCID: PMC7532742 DOI: 10.1007/s12015-020-10046-1] [Citation(s) in RCA: 40] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/24/2020] [Indexed: 12/13/2022]
Abstract
The race among countries and companies to develop efficacious vaccines and therapeutics for the COVID-19 is ongoing fast, with many trials underway. Among this, cell-based therapy is focused on moderate to severe phases of COVID-19, and there have been promising outcomes. Mesenchymal stem cells (MSCs) due to their pro/anti-inflammatory and immune-modulatory behavior, Natural Killer (NK) cells thanks to their capacity of lysing virus-infected cells and regulate the resulting immune response, Dendritic cells thanks to immunotherapy and cell-based vaccine engineering, SARS-CoV2-specific T cells due to stimulate and promote the immune system and MSC-derived exosomes because of cell-free therapy and beneficial manufacturing aspects, hold great promises for cell-based therapy applications for treating COVID-19 and similar viral infections. Moreover, recently, an innovative approach to COVID-19 based on engineered human MSC has been introduced, which is continuously evacuated and degraded by the body's immune system during the antigen recognition process. However, the economic situation of governments and nations, and the cost of therapeutics influence the clinical approaches to manage and exit from this pandemic. This summary describes cell-based clinical trials and the cost-utility aspects of cell therapy. In this regard, limited clinical studies have been reported; while, several clinical trials have been approved for starting phases 2 and 3 of their trials for treating COVID-19 patients with acute respiratory distress syndrome. Regarding the cost of cell therapy, many believe that the high cost of cell-based therapy will decrease substantially. Hence, there are hopes that cellular therapy can be approved soon for the treatment of viral diseases such as COVID-19. Graphical abstract.
Collapse
Affiliation(s)
- Ali Golchin
- Department of Clinical Biochemistry and Applied Cell Sciences, Faculty of Medicine, Urmia University of Medical Sciences, Urmia, Iran. .,Regenerative Medicine Group (REMED), Universal Scientific Education and Research Network (USERN), Urmia, Iran.
| |
Collapse
|
37
|
Senger MR, Evangelista TCS, Dantas RF, Santana MVDS, Gonçalves LCS, de Souza Neto LR, Ferreira SB, Silva-Junior FP. COVID-19: molecular targets, drug repurposing and new avenues for drug discovery. Mem Inst Oswaldo Cruz 2020; 115:e200254. [PMID: 33027420 PMCID: PMC7534958 DOI: 10.1590/0074-02760200254] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2020] [Accepted: 09/01/2020] [Indexed: 01/18/2023] Open
Abstract
Coronavirus disease 2019 (COVID-19) caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is a highly contagious infection that may break the healthcare system of several countries. Here, we aimed at presenting a critical view of ongoing drug repurposing efforts for COVID-19 as well as discussing opportunities for development of new treatments based on current knowledge of the mechanism of infection and potential targets within. Finally, we also discuss patent protection issues, cost effectiveness and scalability of synthetic routes for some of the most studied repurposing candidates since these are key aspects to meet global demand for COVID-19 treatment.
Collapse
Affiliation(s)
- Mario Roberto Senger
- Fundação Oswaldo Cruz-Fiocruz, Instituto Oswaldo Cruz, Laboratório
de Bioquímica Experimental e Computacional de Fármacos, Rio de Janeiro, RJ,
Brasil
| | - Tereza Cristina Santos Evangelista
- Universidade Federal do Rio de Janeiro, Instituto de Química,
Laboratório de Síntese Orgânica e Prospecção Biológica, Rio de Janeiro, RJ,
Brasil
| | - Rafael Ferreira Dantas
- Fundação Oswaldo Cruz-Fiocruz, Instituto Oswaldo Cruz, Laboratório
de Bioquímica Experimental e Computacional de Fármacos, Rio de Janeiro, RJ,
Brasil
| | - Marcos Vinicius da Silva Santana
- Fundação Oswaldo Cruz-Fiocruz, Instituto Oswaldo Cruz, Laboratório
de Bioquímica Experimental e Computacional de Fármacos, Rio de Janeiro, RJ,
Brasil
| | - Luiz Carlos Saramago Gonçalves
- Fundação Oswaldo Cruz-Fiocruz, Instituto Oswaldo Cruz, Laboratório
de Bioquímica Experimental e Computacional de Fármacos, Rio de Janeiro, RJ,
Brasil
| | - Lauro Ribeiro de Souza Neto
- Fundação Oswaldo Cruz-Fiocruz, Instituto Oswaldo Cruz, Laboratório
de Bioquímica Experimental e Computacional de Fármacos, Rio de Janeiro, RJ,
Brasil
| | - Sabrina Baptista Ferreira
- Universidade Federal do Rio de Janeiro, Instituto de Química,
Laboratório de Síntese Orgânica e Prospecção Biológica, Rio de Janeiro, RJ,
Brasil
| | - Floriano Paes Silva-Junior
- Fundação Oswaldo Cruz-Fiocruz, Instituto Oswaldo Cruz, Laboratório
de Bioquímica Experimental e Computacional de Fármacos, Rio de Janeiro, RJ,
Brasil
| |
Collapse
|
38
|
|
39
|
Mahmoud DB, Shitu Z, Mostafa A. Drug repurposing of nitazoxanide: can it be an effective therapy for COVID-19? J Genet Eng Biotechnol 2020; 18:35. [PMID: 32725286 PMCID: PMC7385476 DOI: 10.1186/s43141-020-00055-5] [Citation(s) in RCA: 48] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2020] [Accepted: 07/22/2020] [Indexed: 02/07/2023]
Abstract
Background The current outbreak of pandemic coronavirus disease 2019 (COVID-19) aggravates serious need for effective therapeutics. Over recent years, drug repurposing has been accomplished as an important opportunity in drug development as it shortens the time consumed for development, besides sparing the cost and the efforts exerted in the research and development process. Main body of the abstract The FDA-approved antiparasitic drug, nitazoxanide (NTZ), has been found to have antiviral activity against different viral infections such as coronaviruses, influenza, hepatitis C virus (HCV), hepatitis B virus (HBV), and other viruses signifying its potential as a broad spectrum antiviral drug. Moreover, it has been recently reported that NTZ exhibited in vitro inhibition of SARS-CoV-2 at a small micromolar concentration. Additionally, NTZ suppresses the production of cytokines emphasizing its potential to manage COVID-19-induced cytokine storm. Furthermore, the reported efficacy of NTZ to bronchodilate the extremely contracted airways can be beneficial in alleviating COVID-19-associated symptoms. Short conclusion All these findings, along with the high safety record of the drug, have gained our interest to urge conductance of clinical trials to assess the potential benefits of using it in COVID-19 patients. Thus, in this summarized article, we review the antiviral activities of NTZ and highlight its promising therapeutic actions that make the drug worth clinical trials.
Collapse
Affiliation(s)
- Dina B Mahmoud
- Pharmaceutics Department, National Organization for Drug Control and Research, Giza, Egypt.
| | - Zayyanu Shitu
- Hospital Services, Management Board, Ministry of Health, Zamfara State, Gusau, Nigeria
| | - Ahmed Mostafa
- Centre of Scientific Excellence for Influenza Viruses, National Research Centre, Cairo, Egypt
| |
Collapse
|
40
|
De Savi C, Hughes DL, Kvaerno L. Quest for a COVID-19 Cure by Repurposing Small-Molecule Drugs: Mechanism of Action, Clinical Development, Synthesis at Scale, and Outlook for Supply. Org Process Res Dev 2020; 24:940-976. [PMID: 37556267 PMCID: PMC7294877 DOI: 10.1021/acs.oprd.0c00233] [Citation(s) in RCA: 60] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2020] [Indexed: 02/08/2023]
Abstract
The outbreak of the COVID-19 pandemic has spurred an intense global effort to repurpose existing approved drugs for its treatment. In this review, we highlight the development of seven small-molecule drugs that are currently being assessed in clinical trials for the treatment of COVID-19. Three sections are presented for each drug: (1) history, mechanism of action, and status of clinical trials; (2) scalable synthetic routes and final forms; and (3) outlook for supply should clinical trials show treatment efficacy. A brief overview of diagnostic testing and vaccine development is also presented.
Collapse
Affiliation(s)
- Chris De Savi
- Kymera
Therapeutics, 300 Technology Square, Second Floor,
Cambridge, Massachusetts 02139, United
States
| | - David L. Hughes
- Cidara Therapeutics,
Inc., 6310 Nancy Ridge Drive, Suite 101, San
Diego, California 92121, United States
| | - Lisbet Kvaerno
- Hypha Discovery
Ltd, 154C Brook Drive, Milton Science Park,
Abingdon OX14 4SD, United Kingdom
| |
Collapse
|
41
|
Pepperrell T, Pilkington V, Owen A, Wang J, Hill AM. Review of safety and minimum pricing of nitazoxanide for potential treatment of COVID-19. J Virus Erad 2020. [PMID: 32405422 PMCID: PMC7332204 DOI: 10.1016/s2055-6640(20)30017-0] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Background Many treatments are being assessed for repurposing to treat coronavirus disease 2019 (COVID-19). One drug that has shown promising results in vitro is nitazoxanide. Unlike other postulated drugs, nitazoxanide shows a high ratio of maximum plasma concentration (Cmax), after 1 day of 500 mg twice daily (BD), to the concentration required to inhibit 50% replication (EC50) of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (Cmax : EC50 roughly equal to 14:1). As such, it is important to investigate the safety of nitazoxanide for further trials. Furthermore, treatments for COVID-19 should be cheap to promote global access, but prices of many drugs are far higher than the costs of production. We aimed to conduct a review of the safety of nitazoxanide for any prior indication and calculate its minimum costs of production. Methods A review of nitazoxanide clinical research was conducted using EMBASE and MEDLINE databases, supplemented by
ClinicalTrials.gov. We searched for phase 2 or 3 randomised controlled trials (RCTs) comparing nitazoxanide with placebo or active control for 5–14 days in participants experiencing acute infections of any kind. Data extracted were grade 1–4 and serious adverse events (AEs). Data were also extracted on gastrointestinal (GI) AEs, as well as hepatorenal and cardiovascular effects. Active pharmaceutical ingredient cost data from 2016 to 2019 were extracted from the Panjiva database and adjusted for 5% loss during production, costs of excipients, formulation, a 10% profit margin and tax. Two dosages, at 500 mg BD and a higher dose of 1100 mg three times daily (TDS), were considered. Our estimated costs were compared with publicly available list prices from a selection of countries. Results Nine RCTs of nitazoxanide were identified for inclusion. These RCTs accounted for 1514 participants and an estimated 95.3 person-years-of-follow-up. No significant differences were found in any of the AE endpoints assessed, across all trials or on subgroup analyses of active- or placebo-controlled trials. Mild GI AEs increased with dose. No hepatorenal or cardiovascular concerns were raised, but few appropriate metrics were reported. There were no teratogenic concerns, but the evidence base was very limited. Based on a weighted-mean cost of US $61/kg, a 14-day course of treatment with nitazoxanide 500 mg BD would cost $1.41. The daily cost would therefore be $0.10. The same 14-day course could cost $3944 in US commercial pharmacies, and $3 per course in Pakistan, India and Bangladesh. At a higher dose of 1100 mg TDS, our estimated cost was $4.08 per 14-day course, equivalent to $0.29 per day. Conclusion Nitazoxanide demonstrates a good safety profile at approved doses. However, further evidence is required regarding hepatorenal and cardiovascular effects, as well as teratogenicity. We estimate that it would be possible to manufacture nitazoxanide as generic for $1.41 for a 14-day treatment course at 500 mg BD, up to $4.08 at 1100 mg TDS. Further trials in COVID-19 patients should be initiated. If efficacy against SARS-CoV-2 is demonstrated in clinical studies, nitazoxanide may represent a safe and affordable treatment in the ongoing pandemic.
Collapse
Affiliation(s)
| | | | - Andrew Owen
- Department of Molecular and Clinical Pharmacology, University of Liverpool, UK.,MRC Centre for Drug Safety Science, University of Liverpool, UK
| | | | - Andrew M Hill
- Department of Molecular and Clinical Pharmacology, University of Liverpool, UK
| |
Collapse
|