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Drugs for COVID-19: A Publishing Epidemic

written by Dr. Stephen A. Berger

As of April 9, PubMed listed 2,868 scientific publications that incorporate the word “COVID”.   323 of these (11.3%) were related to drugs under study for the treatment of the disease. No fewer than thirty-one such drugs had been proposed since this pandemic first appeared on the planet four months earlier.   

Graph 1 depicts the cumulative numbers of COVID-19 infection (per 100,000 global population) and introductions of relevant drugs into the Literature from February 14 to April 3. Note that both increased by a factor of approximately 16-fold during this period.

Graph of reported COVID-19 cases vs suggested new drugs

In a biological sense, the “doubling time” for drug publication is similar to that of COVID-19 infection. Indeed, just as there is an incubation period between acquisition of the disease and the reporting of a given case, there is a delay period between submission of an article and its appearance in PubMed (one suspects that this process has been streamlined during the current emergency). There may even be an element of “contagion” at work in the publishing “explosion”.  

Many of the papers on COVID are repetitive, and an increasing number are reactive; ie, published in support – or in criticism – of other papers. The most notable example involves the use of Hydroxychloroquine. 

Inevitably, a wide variety of existing antiviral drugs have been proposed for the treatment of COVID-19. These agents are already used for the treatment of Influenza, Hepatitis C, HIV / AIDS, and other infections. Initial results suggest that many of these, which are commonly administered in clinical practice (Oseltamivir, Paramivir, Zanamivir, Ganciclovir, Acyclovir) lack activity against SARS-CoV-2, the agent of COVID-19.   Others that have been mentioned include Favipiravir,  Galidesivir, Interferon-alpha, Interferon-beta, Lepdipasvir, Lopinavir, Remdesivir, Ribavirin, Ritonavir,   Sofusbuvir, Telbivudine, Tenofovir, and Velpatasvir. Remdisivir and Lopinavir (used in the treatment of Ebola and HIV / AIDS, respectively) have attracted much interest in recent days. 

The treatment of COVID-19 has increasingly focused on drugs that either block viral attachment or modulate the vascular and immune responses which cause the actual “disease”. Anecdotal reports and small case series have suggested that Chloroquine and Hydroxychloroquine, drugs used in the treatment of malaria and certain inflammatory diseases, are effective in controlling these processes. Colchicine, Ivermectin, Metronidazole, Statin drugs, Sarilumab, Teicoplanin, and Tocilizumab may act through similar mechanisms. Not surprisingly, many publications have also examined the use of Traditional Chinese Medicines and serum obtained from patients who had recovered from COVID-19.

In some cases, these drugs have been advocated for both the prevention and the treatment of COVID-19. As such, the concept of “prevention” also extends to hospital personnel and individuals in the community who will no longer be at risk from the treated patient. Although the element of drug side effects is often mentioned in relevant publications, few point out that patients most likely to receive these agents (elderly people with underlying diseases) are likely to be receiving other drugs that could interact with the agent in question.  

The following is an alphabetical list of drugs that have been considered for the treatment of COVID-19, indicating the number of relevant publications indexed by PubMed to April 10, 2020. 

Drugs Proposed for the Treatment of COVID-19: Publications Indexed on PubMed

Drug or Other Agent Publications – number
Arbidol 5
Azithromycin 3
Baricitinib 6
Chloroquine 45
Convalescent serum 16
Colchicine 1
Emetine 2
Favipiravir 5
Galidesivir 1
Homoharringtonin 1
Hydroxychloroquine 35
Interferon alpha 4
Interferon beta 3
Ivermectin 1
Lepdipasvir 1
Lopinavir 31
Metronidazole 1
Nicotinamide 1
Remdesivir 20
Ribavirin 14
Ritonavir 29
Sarilumab 1
Sofusbuvir 2
Statins 4
Teicoplanin 1
Tenofovir 1
Tilorone 1
Tocilizumab 14
Traditional Chinese Medicine 46
Telbivudine 1
Velpatasvir 1
Vitamin B12 1

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