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

Abstract

Introduction: The current COVID-19 pandemic has resulted in disastrous human and economic costs, mainly due to the absence of specific treatments to ameliorate the effects of this emerging viral disease. Complementary to immunotherapies, drug repurposing is possibly the best option to arrive at COVID-19 treatments in the mid-term. Areas covered: Repurposing prospects undergoing clinical trials or with some level of evidence emerging from clinical studies are reviewed. Furthermore, we discuss some possible intellectual property and commercial barriers to drug repurposing, and some strategies to facilitate equitable access to incoming therapeutic solutions, highlighting the importance of collaborative drug discovery models. Finally, based on a critical analysis of the available literature about in silico screens against SARS-CoV-2 main protease we 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 agent, remdesivir, as the first treatment for COVID-19, and it is highly probable that repurposed drugs will be first among incoming approvals against SARS-CoV-2. The implementation of collaborative drug discovery models to address the current emergency should be underlined; hopefully, the present experience will help to consolidate the much-needed collaborative philosophy within the drug discovery community. Considering the high expectations of the whole society regarding 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. 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.