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

Get local stories you won't find anywhere else right to your inbox.
Sign up here

Just Posted

A health worker holds a vial of AstraZeneca vaccine to be administered to members of the police at a COVID-19 vaccination center in Mainz, Germany, Thursday, Feb. 25, 2021. (Andreas Arnold/dpa via AP)
43 new COVID-19 cases in Interior Health

368 cases in the region remain active

The Williams Lake Trail Riders Arena is slated to have a new roof installed this spring after funding from the province’s Community Economic Recovery Infrastructure Program. (Greg Sabatino photo - Williams Lake Tribune)
Trail Riders Arena, stable stalls, to get new roof at Stampede Grounds

Some of the stalls currently aren’t able to be rented out due to leaks in the roof

A sign is seen this past summer outside Yunesit’in Government office west of Williams Lake reminding visitors and members to stay safe amid the COVID-19 pandemic. (Rebecca Dyok photo)
Yunesit’in First Nation completes second round of vaccinations

A total of 26 people have since recovered from COVID-19 after having tested positive

A 100 Mile RCMP officer stands watch at the intersction of Highway 97 and Horse Lake Road. (Patrick Davies photo - 100 Mile Free Press)
Volunteers, police search Highway 97 for articles related to high-speed chase

Search will stretch from Canco Gas Station in Lac La Hache to 150 Mile House.

An aerial photograph captures snowmobile tracks in the Cameron Ridge area earlier this year, which is closed to snowmobilers. The closures are in place to protect sensitive caribou herds. (Conservation Officer Service photo)
Snowmobilers fined for operating in closed caribou habitat near Likely, B.C.

The investigation revealed they had spent several hours in the closure leaving extensive tracks

Health Minister Adrian Dix looks on as Dr. Bonnie Henry pauses for a moment as she gives her daily media briefing regarding COVID-19 for British Columbia in Victoria, B.C. THE CANADIAN PRESS/Jonathan Hayward
7 additional deaths and 542 new COVID-19 cases in B.C.

Provincial health officials reported 18 new COVID-19 cases linked to variants of concern

Cannabis bought in British Columbia (Ashley Wadhwani/Black Press Media)
Is it time to start thinking about greener ways to package cannabis?

Packaging suppliers are still figuring eco-friendly and affordable packaging options that fit the mandates of Cannabis Regulations

The City of Vancouver estimates there are 3,500 Canada geese in the city right now, and that number is growing. (Bruce Hogarth)
Help tame Vancouver’s Canada goose population by reporting nests: park officials

The city is asking residents to be on the lookout so staff can remove nests or addle eggs

Chief Justice Christopher Hinkson (Office of the Chief Justice)
Judge questions whether B.C.’s top doctor appreciated right to religious freedom

Lawyer for province says Dr. Henry has outlined the reasons for her orders publicly

A sample of guns seized at the Pacific Highway border crossing from the U.S. into B.C. in 2014. Guns smuggled from the U.S. are used in criminal activity, often associated with drug gangs. (Canada Border Service Agency)
B.C. moves to seize vehicles transporting illegal firearms

Bill bans sale of imitation or BB guns to young people

BC Housing minister David Eby is concerned that Penticton council’s decision to close a local homeless shelter will result in a “tent city” similar to this one in Everett, Wa. (Olivia Vanni / Black Press file)
‘Disappointed and baffled’ B.C. housing minister warns of tent city in Penticton

Penticton council’s decision to close a local homeless shelter could create tent city, says David Eby

A recently published study out of UBC has found a link between life satisfaction levels and overall health. (Pixabay)
Satisfied with life? It’s likely you’re healthier for it: UBC study

UBC psychologists have found those more satisfied with their life have a 26% reduced risk of dying

A vial of some of the first 500,000 of the two million AstraZeneca COVID-19 vaccine doses that Canada has secured through a deal with the Serum Institute of India in partnership with Verity Pharma at a facility in Milton, Ont., on Wednesday, March 3, 2021. THE CANADIAN PRESS/Carlos Osorio - POOL
Federal panel recommends 4-month gap between COVID vaccine doses due to limited supply

The recommendation applies to all COVID-19 vaccines currently approved in Canada

A vial of Oxford-AstraZeneca COVID-19 vaccine is pictured at a family doctor office, Thursday, Feb. 25, 2021 in Paris. THE CANADIAN PRESS/AP -Christophe Ena
Trudeau ‘optimistic’ that timeline for rollout of COVID vaccines can be accelerated

Canada set to receive more than 6M COVID-19 vaccine dose than initially expected, by end of March

Most Read