by Professor Gino Martini, RPS Chief Scientist
Until recently there was no recommended treatment for COVID-19 although many therapeutic options were being explored from antivirals, steroids, non-steroidal anti-inflammatory drugs and anti-malarial drugs such as the much talked about hydroxychloroquine. Healthcare professionals were faced with life and death situations, forced to use existing medicines that were developed to treat different diseases, such as arthritis or Ebola – what we call ‘off-label’ and compassionate usage.
We entered a phase of treat first and conduct the clinical trials at the same time – which is simply unprecedented and required a massive overhaul of how regulators, the industry and academia operated!
Due to the varied patient response to SARS-CoV-2, high quality clinical trials with robust controls were needed so that clinicians could tease out whether the drug was actually working rather than the patient just getting better naturally.
Hence the UK launched the RECOVERY and REMAP-CAP clinical trials, with the RECOVERY trial focusing on existing drug treatments, and REMAP-CAP aimed at identifying the best combination of treatments in critical care.
The RECOVERY trial is the fastest growing trial in medical history and enrolled 1,000 patients at 132 hospitals in its first 15 days!
So far, the results are promising with the steroid dexamethasone showing effectiveness in COVID-19 patients requiring mechanical assistance in breathing (reduced death by 1/3 in ventilated patients and by 1/5 in those patients requiring oxygen but not ventilated) and the anti-viral drug Remdesivir helping some COVID-19 patients to recover more rapidly from the disease.
However, it is still early days and there have been criticisms of the early sharing of data without the usual peer review. The disease is so complex that different drugs may be more or less useful at different stages and in different sub-groups as is the case with the anti-inflammatory drugs.
Here is where the Clinical Trials Pharmacists play a massive role in helping to coordinate these huge clinical programmes. We, as pharmacists, often overlook the valuable role that pharmacists undertake in the design, implementation and leading of such trials. We should showcase this role and its importance to the wider profession and to early careers pharmacists who may want to explore new career opportunities.
The hunt for a vaccine
At the time of writing, there are 4 different vaccine classes that the government has already secured for the UK. These are:
- adenoviral vaccines (Oxford/AstraZeneca, Janssen)
- mRNA vaccines (BioNTech/Pfizer & Imperial)
- inactivated whole virus vaccines (Valneva)
- protein adjuvant vaccines (GSK/Sanofi, Novavax)
So far, the results have been promising and we can only hope that a vaccine will be secured. I am very confident, as history tells us, that the UK has a great track record in isolating vaccines, such as the early flu vaccine developed around 1918. This flu vaccine was developed by the Royal Army Medical College, using lung scrapings from infected patients and the vial below is one of our exhibits at the Society’s museum. This underpins the essential role pharmacists play in flu vaccination, and will no doubt play in vaccinating people against SARS-CoV-2 in the future.
I for sure will be embracing the vaccine. Please keep safe and well in the meantime and remember to wash your hands and wear a face mask or covering when instructed.
This blog is the first in a series of articles highlighting the important issues affecting the world of pharmaceutical science, keeping you up to date on the main developments and new initiatives. If you want to hear more from the key people in pharmaceutical industry, talking about topics including research efforts into COVID-19 vaccines and treatments, have a listen to our PharmSci Today Podcast, hosted weekly by Professor Gino Martini.