Dr. Jordan Feld, a liver specialist at UHN’s Toronto Centre for Liver Disease, poses in this recent handout photo. More than a year after COVID-19 emerged, few therapies exist and many that do are expensive, cumbersome and unproven, say experts who blame disjointed data, funding and communication as factors derailing efforts to tamp down disease. While warp speed efforts to develop vaccines have produced several promising options in mere months, there’s been comparatively little push for treatment tools to cut severe cases and deaths that are crippling health-care systems, says COVID-19 researcher Dr. Feld. THE CANADIAN PRESS/HO - University Health Network

Dr. Jordan Feld, a liver specialist at UHN’s Toronto Centre for Liver Disease, poses in this recent handout photo. More than a year after COVID-19 emerged, few therapies exist and many that do are expensive, cumbersome and unproven, say experts who blame disjointed data, funding and communication as factors derailing efforts to tamp down disease. While warp speed efforts to develop vaccines have produced several promising options in mere months, there’s been comparatively little push for treatment tools to cut severe cases and deaths that are crippling health-care systems, says COVID-19 researcher Dr. Feld. THE CANADIAN PRESS/HO - University Health Network

Experts say race for COVID drugs dogged by false promises, lack of co-ordination

Urgency for effective drugs has only become more intense amid Canada’s vaccine deployment debacle

More than a year after COVID-19 emerged, few therapies exist and many that do are expensive, cumbersome and unproven, say experts who suggest disjointed data, funding and communication are derailing efforts to tamp down disease.

While warp speed efforts to develop vaccines have produced several promising options in mere months, there’s been comparatively little push for treatment tools to cut severe cases and deaths that are crippling health-care systems, says COVID-19 researcher Dr. Jordan Feld, a liver specialist at UHN’s Toronto Centre for Liver Disease.

The urgency for effective drugs has only become more intense amid Canada’s vaccine deployment debacle and the rise of more infectious variants, adds Feld, whose research into a promising antiviral treatment was recently published in Lancet Respiratory Medicine.

“It would have been nice to have seen a little more co-ordinated effort to try to develop antiviral therapies early on, and that’s probably hampered all of our efforts at developing therapeutics,” says Feld, calling for more national and global co-ordination of clinical studies and data sharing.

Feld’s research centres on a protein that can activate cellular pathways to kill invading viruses. Early data on injecting the drug, called peginterferon-lambda, into COVID patients found it significantly sped recovery for patients enrolled in a small Phase 2 clinical trial.

The 30 participants who received the experimental drug were four times more likely to clear the infection within a week than those in the placebo group.

Slightly different studies on peginterferon-lambda include efforts at the University of Toronto, New York’s Mount Sinai medical school, and Johns Hopkins, Harvard and Stanford universities, says Feld.

But all were planned independently when a shared effort could have allowed scientists to collaborate on trial design and divide work based on expertise and local situations, he says. He envisions an approach similar to the Manhattan Project, which was a Second World War-era effort to develop an atomic weapon.

“This is a national emergency, we need to develop the bomb – in this case we need to develop the antiviral bomb or the vaccine bomb,” he says.

Most clinicians have a relatively scant arsenal to fight COVID-19, agrees Hamilton infectious disease physician Zain Chagla.

“The fact that we have millions and millions of patients across the world and our clinical trial data is still only coming out with thousands of patients’ experience is an absolute shame,” says Chagla, an associate professor of medicine at McMaster University.

“We should have had more patients enrolled in clinical trials to robustly answer these questions of what therapies worked or didn’t work.”

READ MORE: Clinical trial of COVID-19 drug for severe cases to be carried out at Surrey hospital

Dexamethasone, given to hospitalized patients who need help breathing, has been among the most significant therapies to tackle COVID-19 in a field littered with false promises.

Feld points to hydroxychloroquine as the poster child of misguided, politically motivated treatment bids, while more recently, unproven hype has surrounded the anti-parasitic drug Ivermectin. Premature promotion does all scientific research a disservice, he says.

“That probably actually hinders studies from being done, because when people feel like it’s good or bad – and especially if that changes with their political leanings – that may really affect the way you get people enrolling in a trial or not enrolling in a trial,” says Feld.

On top of that, Chagla says it’s been hard to keep some clinicians from giving unproven therapies to suffering patients with no other options.

“That was the issue in the beginning, for sure – people felt uncomfortable having a patient on a ventilator without giving them hydroxychloroquine or giving them some other drug to make it feel like they’re doing something based on a few case reports and a few theories.”

Just last week, the Quebec government cautionedclinicians against embracing colchicine as a COVID-19 therapy after the Montreal Heart Institute touted the common gout medication as “a major scientific discovery.”

Quebec’s National Institute for Excellence in Health and Social Services acknowledged the institute’s study showed positive results, but said the benefit was too small.

While a number of Canadian study sites are part of a World Health Organization trial known as Solidarity, Chagla says data from every Canadian COVID-19 patient should be shared for vital learning along the lines of the U.K.’s national clinical Recovery trial.

“We don’t know other than dexamethasone whether or not these therapies work in significant numbers. Remdesivir maybe, but it’s still even controversial there. Why are we not doing this now, 11 months later? We have the talent, we have the personnel, we have the patients, we have the health-care staff,” says Chagla.

“We should be able to be co-ordinating such that every patient that’s hospitalized for COVID-19 receives a therapy that informs practice for the next patient.”

Health Canada has authorized just two drugs specifically for COVID-19 treatment – Gilead Sciences’ remdesivir and Eli Lilly’s bamlanivimab – and is fast-tracking the review of others.

But while bamlanivimab claims to ease and prevent COVID-19 symptoms among mild-to-moderate cases, there’s limited safety data, it costs US$1,250 per dose and is difficult to administer because it involves an hour-long intravenous infusion which could redirect front-line medical staff.

British Columbia’s Health Minister Adrian Dix said Monday a clinical trial would examine bamlanivimab’s potential at Surrey Memorial Hospital, and Alberta Health Services says it’s considering a trial to determine “potential for benefit and feasibility of use.”

Dr. Niall Ferguson, head of critical care at the University Health Network and Sinai Health System, sees potential in early data for tocilizumab, approved for use in Canada to treat rheumatoid arthritis.

Although evolving data has been mixed and is still emerging, Ferguson notes the monoclonal antibody is already being used off-label for some severe patients.

“It’s happening on a bit of an ad hoc basis when patients are caught at the right time and look like they may have a bit of additional inflammation going on that could be set aside with this drug,” says Ferguson, who looks after the most severe COVID-19 cases Toronto General Hospital.

Ferguson is also bullish on a global study that suggests blood-thinners can prevent some moderate patients from deteriorating further, expecting to see “widespread use of anticoagulation in just a few weeks” once findings are released.

Therapies have gained ground in the past year, Ferguson insists, crediting lower hospital mortality rates to various lessons learned, including better supportive care, earlier interventions, and the reversal of well-meaning strategies early in the pandemic that actually did more harm than good. That included the overuse of mechanical ventilators and a misguided belief that steroids should be avoided in severe COVID-19 cases, he says.

While the pandemic now includes worrying new variants, Feld says peginterferon-lambda activates multiple antiviral pathways, making it “exceedingly unlikely” for a virus to become resistant to all of them at the same time.

It’s best deployed as early as possible to cut not only the chance of severe illness but possible spread to others, he says, envisioning the day someone might get an injection the moment a point-of-care test revealed COVID-19.

“Vaccines are great for preventing people from getting the infection, but for those who do still get the infection it’s important to have therapeutics to treat them,” he says.

Cassandra Szklarski, The Canadian Press


Like us on Facebook and follow us on Twitter.

Want to support local journalism during the pandemic? Make a donation here.

Coronavirus

Just Posted

(File photo from The Canadian Press)
Red Deer down to 66 active COVID-19 cases

Red Deer has lowest number of active cases since last November

Orange shirts, shoes, flowers and messages are displayed on the steps outside the legislature in Victoria, B.C., on Tuesday, June 8, 2021 following a ceremony hosted by the Songhees and Esquimalt First Nations in honour of the 215 residential school children whose remains have been discovered buried near the facility in Kamloops, B.C. THE CANADIAN PRESS/Chad Hipolito
Alberta city cancels Canada Day fireworks at site of former residential school

City of St. Albert says that the are where the display was planned, is the site of the former Youville Residential School

FILE – Perry Bellegarde, National Chief of the Assembly of First Nations, takes part in an event on Parliament Hill in Ottawa on Tuesday, July 7, 2020. THE CANADIAN PRESS/Sean Kilpatrick
Indigenous Peoples Day must be a ‘call to action’, says Assembly of First Nations chief

Discovery of children at Kamloops residential school site must lead to change, Perry Bellegarde says

The Government of Alberta identified 115 new COVID-19 cases Sunday, bringing the provincial total to 3,089.
(Black Press file photo)
Alberta reports 100 new cases of COVID-19

The Central zone sits at 218 active cases

The Government of Alberta identified 115 new COVID-19 cases Sunday, bringing the provincial total to 3,089.
(Black Press file photo)
Red Deer drops to 71 active cases of COVID-19

Province adds 127 new cases of the virus

The border crossing into the United States is seen during the COVID-19 pandemic in Lacolle, Que. on February 12, 2021. THE CANADIAN PRESS/Paul Chiasson
VIDEO: Border quarantine to soon lift for fully vaccinated Canadians

Eligible travellers must still take multiple COVID-19 tests

FILE - In this Nov. 29, 2020, file photo, Las Vegas Raiders defensive end Carl Nassib leaves the field after an NFL football game against the Atlanta Falcons in Atlanta. Nassib on Monday, June 21, 2021, became the first active NFL player to come out as gay. Nassib announced the news on Instagram, saying he was not doing it for the attention but because “I just think that representation and visibility are so important.” (AP Photo/John Bazemore, File)
Nassib becomes first active NFL player to come out as gay

More than a dozen NFL players have come out as gay after their careers were over

A pair of Alberta residents were arrested after police responded to a report of a woman who had allegedly been assaulted and confined against her will on June 20, 2021. (File photo)
Salmon Arm RCMP arrest 2 Albertans suspected in alleged assault, unlawful confinement

Firearms, stolen items seized including NHL hockey cards believed to be worth thousands

A man makes his way past signage to a mass COVID-19 vaccination centre at the University of Toronto’s Mississauga campus during the COVID-19 pandemic in Mississauga, Ont., on Monday, May 17, 2021. THE CANADIAN PRESS/Nathan Denette
Canadians encouraged to see mRNA shots as interchangeable as more 2nd doses open up

Doctors urge people not to hesitate if offered Moderna after getting Pfizer for their first shot

Chief of Defence Staff Jonathan Vance sits in the front row during a news conference in Ottawa on June 26, 2020. THE CANADIAN PRESS/Adrian Wyld
Defence committee rises without report on Vance allegations

Committee had been investigating the government’s handling of complaints against former defence chief

Tl’etinqox-lead ceremony at the site of the former St. Joseph’s Mission in Williams Lake, B.C., June 18, 2021. (Angie Mindus photo - Williams Lake Tribune)
‘We are all one people’: Honouring residential school victims and survivors

Love, support and curiousity: Canadians urged to learn about residential schools and their impact

Indigenous rights and climate activists gathered outside Liberty Mutual’s office in Vancouver to pressure the insurance giant to stop covering Trans Mountain. (Photo by Andrew Larigakis)
Activists work to ensure Trans Mountain won’t get insurance

Global campaign urging insurance providers to stay away from Canadian pipeline project

Investigators use a bucket to help recover human remains at a home burned in the Camp fire, Thursday, Nov. 15, 2018, in Magalia, Calif. Many of the missing in the deadly Northern California wildfire are elderly residents in Magalia, a forested town of about 11,000 north of the destroyed town of Paradise. (AP Photo/John Locher)
‘Forever War’ with fire has California battling forests instead

Five of the state’s largest-ever blazes seared California last year, as authorities tackle prevention

Tokyo 2020 President Seiko Hashimoto and IOC President Thomas Bach, on a screen, speak during a five=party online meeting at Harumi Island Triton Square Tower Y in Tokyo Monday, June 21, 2021. The Tokyo Olympics will allow some local fans to attend when the games open in just over a month, Tokyo organizing committee officials and the IOC said on Monday. (Rodrigo Reyes Marin/Pool Photo via AP)
Tokyo Olympics to allow Japanese fans only, with strict limits

Organizers set a limit of 50% capacity — up to a maximum of 10,000 fans

Most Read