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

FILE – Wet’suwet’en hereditary chiefs have agreed to sign a memorandum on rights and title with B.C. and Ottawa, but elected chiefs are demanding it be called off over lack of consultation. (Thom Barker photo)
Wet’suwet’en hereditary chiefs, Lake Babine Nation get provincial funding for land, title rights

Government says it’s a new, flexible model for future agreements between Canada, B.C. and First Nations.

Vanderhoof municipal office sign on Burrard Avenue. (Aman Parhar/Omineca Express)
Vanderhoof council discuss requests from NWRI, airport, BC Wildfire

District of Vanderhoof held their regular public meeting of council on April… Continue reading

The property on which a residential school (pictured) that was torn down years ago in Lower Post is to be the location of a cultural centre. (Indian Residential School History and Dialogue Centre photo)
Lower Post residential school building to be demolished, replaced with cultural centre

Project to be funded by federal and provincial governments, Daylu Dena Council

To send in Letters to the Editor, email aman.parhar@ominecaexpress.com
Letter: Increased aggression towards staff at Omineca Medical clinic

Dr. Davy Dhillon writes letter on behalf of the clinic

Basin Snow Water Index map for Apr. 1, 2021. (BC River Forecast Centre photo/Lakes District News)
Snowpack above normal for Upper Fraser West basin

Snowpack assessments for early April reveals above normal levels for northwestern British… Continue reading

Vancouver resident Beryl Pye was witness to a “concerning,” spontaneous dance party that spread throughout social groups at Kitsilano Beach on April 16. (Screen grab/Beryl Pye)
VIDEO: Dance party erupts at Vancouver’s Kitsilano Beach to the dismay of onlookers

‘It was a complete disregard for current COVID-19 public health orders,’ says Vancouver resident Beryl Pye

Deputy Prime Minister and Minister of Finance Chrystia Freeland responds to a question during Question Period in the House of Commons Tuesday December 8, 2020 in Ottawa. The stage is set for arguably the most important federal budget in recent memory, as the Liberal government prepares to unveil its plan for Canada’s post-pandemic recovery even as a third wave of COVID-19 rages across the country. THE CANADIAN PRESS/Adrian Wyld
Election reticence expected to temper political battle over federal budget

Opposition parties have laid out their own demands in the weeks leading up to the budget

A syringe is loaded with COVID-19 vaccine at a vaccination clinic run by Vancouver Coastal Health, in Richmond, B.C., Saturday, April 10, 2021. THE CANADIAN PRESS/Jonathan Hayward
B.C. to open up COVID vaccine registration to all B.C. residents 18+ in April

Registration does not equate to being able to book an appointment

(Black Press file photo).
UPDATED: Multiple stabbings at Vancouver Island bush party

Three youths hospitalized after an assault in Comox

Selina Robinson is shown in Coquitlam, B.C., on Friday November 17, 2017. British Columbia’s finance minister says her professional training as a family therapist helped her develop the New Democrat government’s first budget during the COVID-19 pandemic, which she will table Tuesday. THE CANADIAN PRESS/Darryl Dyck
B.C. finance minister to table historic pandemic-challenged deficit budget

Budget aims to take care of people during pandemic while preparing for post-COVID-19 recovery, Robinson said

Each spring, the Okanagan Fest-of-Ale is held in Penticton. This year, as a result of the COVID-19 pandemic, the festival will not be held. However, beer is still available. How much do you know about this beverage? (pxfuel.com)
QUIZ: How much do you really know about beer?

Put your knowledge to the test with this short quiz

Lord Tweedsmuir’s Tremmel States-Jones jumps a player and the goal line to score a touchdown against the Kelowna Owls in 2019. The face of high school football, along with a majority of other high school sports, could significantly change if a new governance proposal is passed at the B.C. School Sports AGM May 1. (Malin Jordan)
Power struggle: New governance model proposed for B.C. high school sports

Most commissions are against the new model, but B.C. School Sports (BCSS) and its board is in favour

Pall Bearers carrying the coffin of the Duke of Edinburgh, followed by the Prince of Wales, left and Princess Anne, right, into St George’s Chapel for his funeral, at Windsor Castle, in Windsor, England, Saturday April 17, 2021. (Danny Lawson/Pool via AP)
Trudeau announces $200K donation to Duke of Edinburgh award as Prince Philip laid to rest

A tribute to the late prince’s ‘remarkable life and his selfless service,’ the Prime Minister said Saturday

Most Read