Carl Heneghan

Can antivirals defeat Covid-19?

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Can antivirals help us defeat coronavirus? The odds don’t look good. The use of antiviral compounds against respiratory viruses has a chequered history. Hundreds have been tested; very few have made it to market. And even fewer make a difference. What’s more, the evidence of their impact on mortality rates – the most important outcome of all – is thin.

The race for a magic bullet to overcome Covid-19 has been going for months now. At least 254 treatments are currently undergoing development, ranging from antibodies to cell-mediated treatments. And there are over 3,500 trials underway. Twenty-five different antivirals are in various stages of development, with a variety of funders, from industry to academia to governments and private donors, often in cooperation, sometimes in competition.

In drug development, getting to the market first matters. Regardless of who funds the race, the winners (those compounds ultimately ending up with a licensed indication for use in Covid) are likely to be used in massive quantities at great expense. Like some of their predecessors, they may end up in government stockpiles. In 2014, the UK government increased its antiviral stockpile for influenza to over £500m, despite remaining on the shelf – unused – for over a decade.

But amidst this race, it’s important that these trials are done properly, with the right amount of scrutiny. When it comes to the hunt for a suitable coronavirus antiviral, there is evidence that this isn’t always happening. 

In testing the effects of antivirals, trials should be registered in a publicly accessible database before the first subject to test them on is signed up. Journals and funders insist on such registration, and the WHO considers it essential for research transparency that strengthens the validity and value of the evidence.

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