Can drug repurposing strategies be the solution to the COVID-19 crisis?

ABSTRACT

Introduction: The COVID-19 pandemic resulted in disastrous human and economic costs, mainly due to the initial lack of specific treatments. Complementary to immunotherapies, drug repurposing is possibly the best option to arrive at COVID-19 treatments in the short term.

Areas covered: Repurposing prospects undergoing clinical trials or with some level of evidence emerging from clinical studies are overviewed. The authors discuss some possible intellectual property and commercial barriers to drug repurposing, and strategies to facilitate equitable access to incoming therapeutic solutions, highlighting the importance of collaborative drug discovery models. Based on a critical analysis of the available literature about in silico screens against SARS-CoV-2 main protease, the authors illustrate how frequently overconfident conclusions are being drawn in COVID-19-related literature.

Expert opinion: Most of the current clinical trials on potential COVID-19 treatments are, in fact, drug repurposing examples. In October 2020, the FDA approved a repurposed antiviral, remdesivir, as the first treatment for COVID-19. Considering the high expectations invested in approaching therapeutic solutions, the scientific community must be careful not to raise unrealistic expectations. Today more than ever, the conclusions drawn in scientific reports have to be fully supported by the level of evidence, avoiding any sort of unfounded speculation.

KEYWORDS:

• COVID-19
• COVID
• sars-CoV-2
• drug repurposing
• drug repositioning
• virtual screening
• collaborative drug discovery
• open-source drug discovery
• open innovation
• drug discovery

Article Highlights

• Drug repurposing has already provided treatments for COVID-19 in an expedited manner.

• A substantial fraction of ongoing COVID-19-related clinical trials focuses on drug repurposing.

• Current remdesivir pricing suggests the alleged cost- and time-efficiency of drug repurposing do not necessarily translate into equitable access.

• Several collaborative initiatives to fight COVID-19 have emerged globally; many of them have drug repurposing among their goals.

• It is possible that affordable COVID-19 medications will be available as new therapeutic options enter the market.

• Screening campaigns for COVID-19 treatments frequently arrived at biased conclusions, unsupported by available evidence.

This box summarizes key points contained in the article.

Declaration of interest

CL Bellera, ME Gantner, M Llanos, S Rodriguez; L Gavernet and A Talevi are members of and are supported by the Argentinean National Council of Scientific and Technical Research Council (CONICET) and/or the National University of La Plata (UNLP). The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.

Reviewer Disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Supplementary Data

Supplemental data for this article can be accessed here.

Additional information

Funding

The authors are funded by the Agencia Nacional de Promoción Científica y Tecnológica (ANPCyT), el Desarrollo Tecnológico y la Innovación via grants PICT 2017-0643 and PICT 2016-0165. This work was also supported by the URGENCE nouveau coronavirus fundraising campaign of the Institut Pasteur.