There’s promising early data on many potential Covid-19 treatments. Yet with vaccines in the spotlight, approved treatment options available to doctors remain few and far between.
Last month, the UK government launched an Antivirals Taskforce to introduce new treatments for Covid-19 as early as this fall. Both in the UK and in the EU, the gap between ambition and performance is wide. So far, there currently is only one treatment approved for use by the EMA, Gilead’s remdesivir. By contrast, there are four approved vaccines in the EU and three under rolling review.
Treatment developers say the hope put on vaccines may have motivated early funding choices that channeled resources away from therapies.
“Vaccines are expected to eradicate a virus in the best case,” said Christian Setz, Managing Director of the German biotech ImmunoLogik, which is developing a broad-spectrum antiviral that works against many coronaviruses. “Therefore, of course, a lot of funding was initially allocated to the development of a vaccine.”
“On the other hand, much less money has gone into the development of drugs, which of course clearly slows down development.”
In some cases, early evidence has supported the logic that vaccines could kill the need for treatments. Roche recently pulled a Covid-19 treatment trial in the UK after a national mass vaccination campaign drove down infections dramatically. In Israel, another country that rushed to vaccinate its citizens early on, the Covid-19 daily case and death rate have also plunged.
A major concern, however, is that as the virus mutates, the efficacy of antibodies induced by the vaccines will wane. If that’s the case, the gap in developing treatments can lead to further lives lost. Already in a number of countries including the UK, India, Brazil, and South Africa, mutations of the Covid-19 pathogen have been identified that can potentially evade prior immunity. Governments and vaccine manufacturers have grudgingly recognized that eradicating the virus may not be on the plate, at least yet, and have started to plan ahead for a new round of vaccinations next year.
“I think the healthcare world is realizing we needed resources for both [vaccines and treatments],” said Chris Miller, the CSO of Canadian biotech SaNOtize. The company is developing a nasal spray based on nitric oxide which kills viruses in the nose and mouth and has already been approved in Israel and Bahrain. “We are working very hard to prove to the world that [our treatment] is a significant tool in the overall tool belt to prevent and treat early Covid-19,” Miller added.
A similar approach—a broad-spectrum antiviral in the form of a nasal spray—has been taken by Leyden Labs in the Netherlands, who recently struck a deal for a €40M Series A funding round to advance its product.
“Our team is particularly interested in approaches that bridge the gap between broad measures, such as social distancing, and narrow measures that may be effective against a single or a few viral variants, such as developing a vaccine,” said a Leyden Labs representative.
There are scientific reasons why vaccine candidates are easier to field than treatments. According to Raz Jelinek, Vice President and Dean for Research & Development at Israel’s Ben Gurion University, designing treatments often requires more knowledge of the disease process than vaccines. In the case of Covid-19, “it is harder to figure out the exact pathological mechanisms of the virus,” he added.
Jelinek’s group recently established a startup called Imm-Balance Therapeutics to develop a probiotic treatment based on kefir, a popular Eastern European yoghurt-type drink. According to very early preclinical data in mice, the treatment has the potential to prevent deadly inflammatory reactions seen in severe Covid-19 and bacterial infections. “Our treatment addresses the cytokine storm — which is an immune reaction to the presence of the virus — rather than targeting the virus itself,” Jelinek told me.
Another important issue in developing treatments is the scarcity of reliable biomarkers for predicting severe Covid-19 disease. There is no lack of leads—anything from various vitamin and mineral deficiencies to blood groups to neanderthal genes has been studied as possible biomarkers—but none have so far withstood scientific testing.
A recent player in the Covid-19 biomarker scene is Swiss biotech GeNeuro, which develops treatments targeting viral genes that are normally hidden in our genome, but are expressed in disease. Last month, the company reported results from a study linking the expression of these genes with severe Covid-19.
GeNeuro plans to target both severe Covid-19 cases and the longer-term consequences of the disease — known as ‘long Covid’ — with a monoclonal antibody it has been developing for the treatment of multiple sclerosis and other neurodegenerative diseases.
Treatments for Covid-19 have acquired some early bad rep, in part because many were tried early on in the pandemic with mixed results. Several promising candidates have fizzled—among the more egregious stories is the plasma boom. Nevertheless, studies continue; a large study in the US that evaluates several promising repurposed drug candidates is expected to release data soon. AstraZeneca claims spectacular success with a nasal spray designed to treat asthma, which can calm inflammation in the lungs.
Despite the setbacks, there is a sense of optimism among researchers.
“We hope that a working Covid-19 treatment will be available soon to restore our ability to hug our loved ones again or see a football match again safely,” said Leyden Labs’ spokesperson. “Proactive approaches will be most useful in preventing future pandemics from impacting us as drastically as Covid-19.“
Cover image from Elena Resko. Body text image from Shutterstock.