Early Treatment of COVID-19 Disease: A Missed Opportunity
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COMMENTARY
Early Treatment of COVID-19 Disease: A Missed Opportunity Jamie I. Forrest
. Craig R. Rayner . Jay J. H. Park . Edward J. Mills
Received: August 22, 2020 / Accepted: September 23, 2020 Ó The Author(s) 2020
ABSTRACT Antivirals have demonstrated efficacy in treating other infectious diseases in early stages of disease, reducing morbidity, mortality, and the likelihood of onward transmission. At the time of writing, more than 1900 clinical trials are registered globally to assess the efficacy and safety of candidate therapeutics for COVID-19. The majority of these trials are designed to evaluate the comparative efficacy and safety of
J. I. Forrest J. J. H. Park E. J. Mills (&) Cytel Canada Health Inc., Vancouver, BC, Canada e-mail: [email protected] E. J. Mills Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada C. R. Rayner Certara, NJ, USA J. I. Forrest J. J. H. Park Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada C. R. Rayner Monash Institute of Pharmaceutical Sciences, Monash University, Melbourne, VIC, Australia
candidate therapeutics for the treatment of COVID-19 to prevent death among populations of hospitalized patients with advanced disease. Yet, emerging epidemiological evidence now indicates that the majority of those infected with the SARS-CoV-2, while still infectious, experience minimal or mild disease symptomology. Like HIV and hepatitis C that pioneered treatment as prevention, there is a missed opportunity for trials of early pharmaceutical intervention for COVID-19 disease evaluating not only reductions in morbidity and mortality but also transmissibility. We discuss this clinical research gap within an historical context of viral treatment as prevention for HIV and hepatitis C, and comment on the challenges and opportunities for clinical research of candidate therapeutics for early COVID-19 disease.
Keywords: Clinical trials; COVID-19; Early treatment; Treatment as prevention
Infect Dis Ther
Key Summary Points The majority of clinical trials evaluating candidate therapeutic interventions for the treatment of COVID-19 disease are among populations of hospitalized and severely sick patients Antivirals, shown to be effective in early treatment of other infectious diseases, should continue to be explored in trials among patients with early COVID-19 disease Lessons from other diseases like HIV and hepatitis C demonstrate that early treatment, coupled with frequent and accessible testing, can reduce morbidity, mortality, and likelihood of transmission Investigations of candidate therapeutics for early COVID-19 disease should not compete with ongoing vaccine trials, and given the challenges for distribution and financing of a successful vaccine, early treatment could be important to mitigating the pandemic
DIGITAL FEATURES This article is published with digital features to facilitate understanding of the article. To view digital features for this article go to https://doi. org/10.6084/m9.figshare.12967049.
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