The COVID pandemic has forced everyone to adapt and improvise. While healthcare providers are thinking outside the box and repurposing pharmaceuticals to be used as COVID-19 therapies, patients seek more accessible forms of healthcare. Unfortunately, navigating how to receive safe healthcare is a struggle in the current climate, where offices often overflow with patients. Telemedicine services like Text2Med in Chicago, IL, make getting care stress-free even in this climate.
Repurposing Drugs as COVID Therapies
Although hydroxychloroquine didn’t pan out as hoped, that doesn’t mean other drugs don’t have the potential to be alternative therapies. There is a desperate need for a medication that patients can take orally at home in the early stages of COVID-19. A drug that can control the symptoms of early-stage patients and prevent their hospitalization would allow hospital beds to be reserved for the individuals who are at the most significant risk of dying from virus complications.
To develop a brand new pharmaceutical and push it through the necessary trials and tests to get it approved by the FDA takes precious time. That’s not to mention the necessary actions that would need to occur to mass-produce and distribute a new medication. Repurposing an existing drug is the most practical option as existing drugs are FDA-approved. Repurposing a pharmaceutical to treat the virus would save time, energy, and, most importantly, lives.
Off-Label Drug Use
When an FDA-approved drug is used for a condition it wasn’t created to treat, it is considered off-label use because the drug is being repurposed. The FDA perspective is that once a drug has been FDA-approved, it is at the discretion of the healthcare provider to determine if it would benefit the patient to be used off-label.
Some examples of off-label drug use could be using a type of chemotherapy that is approved to treat Hodgkin’s Lymphoma to treat a different form of cancer. Alternatively, it could be administering a drug as a liquid when it is typically given in capsule form or delivering a drug in a different dosage than is usually prescribed.
An Example: Fluvoxamine
Fluvoxamine is an FDA-approved medication used for the treatment of depression and obsessive-compulsive disorder. It falls into a category of drugs called SSRIs. Studies performed so far have shown that SSRIs appear to stimulate a protein in the central nervous system that regulates inflammatory responses. This discovery is essential data, as some of the most devastating consequences of the coronavirus are related to the inflammation the virus causes.
Lack of Backing
Fluvoxamine is a generic medicine and inexpensive, costing approximately $12 for a treatment course. Since there is no large pharmaceutical team backing the drug and pushing for it to be repurposed, getting adequate funding to host clinical trials has been difficult.
Also, to test the drug’s effectiveness, patients need to be enrolled in studies as near date they were infected with the virus as possible. It’s too early to tell if fluvoxamine will be a crucial player in battling COVID, but many healthcare professionals are excited by its potential.
Matching the Drug to the Disease
There are multiple ways to determine which drugs have the potential to be used to address symptoms of COVID-19. The translational course focuses on understanding what the disease does on a cellular level and looking for a drug that will counteract the effects. High throughput drug screening involves testing numerous medications with the patient’s cells in a petri dish and seeing what happens.
Also, artificial intelligence is used to search for unknown links between pharmaceuticals and disease processes. However, to know if a drug will benefit a COVID patient, it must be tested beyond the lab. Unfortunately, many medications seem promising in theory and lab tests but fail to perform when used in a healthcare setting. Hydroxychloroquine experienced this when it appeared to be the wonder drug but failed to live up to the hype.
Why Testing Is Tricky
Ultimately, the only way to know if a drug can be repurposed for use as COVID therapy is to give it to a COVID-19 patient. It is far from a simple process, as patients often recover from the virus without medicine. The potential for natural recovery makes it extremely difficult to determine if the patient’s improvement was because of the drug or if the patient would have made a full recovery based on their own immune system.
For this reason, it is critical to perform controlled, randomized drug trials. In these trials, patients would be randomly allotted to one of two groups. One group would receive the drug being tested, and the other would receive a placebo, and the results recorded. Without this kind of randomized, highly controlled testing method, it is impossible to determine if a patient would have recovered on their own or not.
Timing Is Critical
Administering the medication at the appropriate time during the virus is also a problematic hurdle in discerning which drugs can be repurposed. For example, the steroid dexamethasone is helpful to patients on ventilators and those who are nearly sick enough for ventilators. However, peculiarly, the steroid ends up being detrimental to the patient’s health if it is given too early during the virus.
Another example of the confusion that can arise relating to timing is the drug tocilizumab, which has had mixed results in studies. Ultimately, the determining factor in whether tocilizumab was effective or not was timing. Unfortunately, it only proved helpful when given during the first 24 hours of the patient being transferred into the intensive care unit.
As more studies are performed on fluvoxamine, hopefully, it will continue to display promise for use in COVID patients. Repurposing an already FDA-approved drug could save countless lives and be the advantage the healthcare community needs to gain some semblance of control over the pandemic.
While determining which pharmaceuticals have the most potential to be repurposed may still be up in the air, your healthcare doesn’t have to be. Call or text the telemedicine service Text2Med in Chicago, IL, today, and you can receive care from board-certified, experienced physicians. Hundreds of healthcare professionals are ready and willing to help, just a call or a text away.