Australia Tapeworm, vertigo and pancreatitis drugs are being trialled as COVID-19 treatments

22:08  24 january  2021
22:08  24 january  2021 Source:   abc.net.au

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It includes drugs to treat tapeworm , pancreatitis , vertigo and cancer. Experts warn clinical trials don't always translate into effective human treatments . The Japanese vertigo drug Ifenprodil is being trialled as a potential treatment for COVID - 19 because of its anti-inflammatory properties.

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a man preparing food in a kitchen: Australian researchers are part of global efforts to trial potential COVID-19 treatments. (Supplied: Nucleus Network) © Provided by ABC Health Australian researchers are part of global efforts to trial potential COVID-19 treatments. (Supplied: Nucleus Network)

With COVID-19 vaccines on their way, it's time to breathe a sigh of relief right? Well, maybe not.

As experts have explained, a vaccine isn't the only thing that will help end the pandemic.

Most vaccines aren't 100 per cent effective and it's not likely we will achieve full coverage in the community.

And, since it will be still many months before the majority of the population will be vaccinated, it is still important to have effective treatments for COVID-19.

Vaccines help prevent us getting sick with COVID-19, but treatments help us get better if we do.

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Australian doctors and patients are at the forefront of global efforts to develop those treatments, but there is still plenty of work underway.

Steroid treatments and better care

One of the most effective treatments for those hospitalised with COVID-19 globally has been steroid treatments.

The use of dexamethasone, along with hydrocortisone and prednisolone, has become routine in hospitals treating COVID-19 patients.

Infectious diseases physician Dr James McMahon said all these treatments were safe, cheap and widely available.

"It's the standard of care now," he said.

Dr McMahon said some of the drop in case fatality rates globally could also be attributed to health professionals simply getting better at managing COVID-19.

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All the COVID - 19 treatments currently in clinical trials. Some potential treatments listed here were previously in clinical testing for other diseases, such as cancer, allowing the trials for COVID - 19 to be fast-tracked.

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"They're better at identifying people who are becoming unwell. Better at identifying people who are vulnerable," he said.

Scientists are also looking at many existing drugs with well-established safety profiles to see if they can be repurposed to help with COVID-19.

Japanese pancreatitis drugs giving a clue

A University of Melbourne study is looking at an obscure drug that has been used to treat pancreatitis in Japan and Korea.

It is called nefamostat and works by binding to one of the two receptors that allow the COVID-19 spike to enter human cells.

Professor Josh Davis is from the Menzies School of Health Research, which is part of the study, and said the drug was very potent in a lab setting.

"There's a small case series of it being used successfully," he said.

The research is part of the ASCOT study, which is also looking at the effectiveness of convalescent plasma and common blood thinners in various combinations.

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"The likelihood is at least one or two of the interventions we're looking at will prove to be effective," Professor Davis said.

"But we don't think any one of these will be a magic bullet."

There are more than 70 hospital and trial sites in Australia, India and Denmark.

Hopeful on heart medication

Another major study by The George Institute for Global Health and University of Sydney is looking at whether common blood pressure medications, called angiotensin receptor blockers, could help reduce the impact of coronavirus.

At the start of the pandemic there were fears these medications might make people more susceptible to COVID-19, which have since been shown to be unfounded.

The new phase four study led by Professor Meg Jardine is looking at common angiotensin receptor blockers (ARBs) like candesartan (Atacand), irbesartan, lorsartan and telmisartan.

Studies to date have shown people already taking these medications do not get any more sick than the rest of the population if they get COVID-19.

Professor Jardine's team wants to take that a step further with the CLARITY study, and will give the drugs to vulnerable patients who don't normally take them and measure whether it impacts the outcome of those who may get COVID-19.

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Professor Jardine said the medications worked on a body system involving hormones and enzymes produced by the kidneys and lungs that got hijacked by COVID-19 infection.

"ARBs block part of that system. Most likely these are beneficial," she said.

Inhalers, cancer drugs in the mix

In a trial specially designed for cancer patients, the Peter MacCallum Cancer Centre in Melbourne is studying the effectiveness of three different therapies.

The first is whether inhaling a common cancer drug and anti-viral called interferon will stop the COVID-19 virus from infecting people.

The theory is that the medication can block the virus from entering the cells in the nose and upper respiratory tract.

A Chinese study found it prevented healthcare workers from catching the virus, but in Australia, lead investigator Professor Monica Slavin warned that study was limited.

"It wasn't a really well-conducted study, but it's promising," she said.

As part of the C-SMART trial, researchers are also looking at whether a cancer drug called selinexor can help.

The medication has both anti-inflammatory and anti-viral properties and has previously been used to treat some blood cancers.

"It stops the construction of some of the proteins that are used to make the virus replicate," Professor Slavin said.

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The third part of the study is investigating whether a leukaemia drug developed in Australia called lenzilumab can also be effective.

It is a type of antibody and works to maintain the integrity of lung cells, which are badly affected by COVID-19.

It works in a similar fashion to the arthritis drug tocilizumab, which has shown promising results in treating coronavirus.

"It acts in the early point of the infection process. We think it could be potentially quite useful," Professor Slavin said.

While the study is looking at cancer patients, Professor Slavin said positive results might also be translated to other vulnerable groups, or even healthy populations.

New jobs for old drugs

A joint Monash University and Alfred Hospital study has been looking at an antiviral medication called favipiravir.

It was developed in the 1990s in Japan as a potential drug for an influenza pandemic.

It was quickly superseded by the more effective antiviral Tamiflu.

Favipiravir became interesting to researchers in the fight against the pandemic because it worked in a similar way to the well-known antiviral remdesivir.

Both drugs stop the RNA inside a virus replicating.

Lead investigator Dr McMahon said it essentially placed a false building block in between the strands of RNA inside the virus as they try to multiply.

"It interrupts the new RNA strand," he said.

The infectious diseases physician said studies to date had been small but that the drug might shorten the lifespan of infection by up to two days, especially in early stages of mild or moderate cases.

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"The idea is to get to people before they get more sick," he said

But some of the overseas findings have been criticised for not being large enough to be statistically significant.

The big plus of favipiravir is that it can be taken orally, as opposed to remdesivir which is given by intravenous drip.

For this reason it can also be given to patients who are not sick enough to be hospitalised.

While it's well-tested and safe, there is one big downside: it can't be given to pregnant women.

Vertigo, bird flu drug has some promise

Royal Melbourne Hospital and Princess Alexandra Hospital in Queensland are among 10 international sites trialling a medication shown to be useful in treating bird flu.

The drug, called ifenprodil, is being tested by a Canadian drug company called Algernon Pharmaceuticals.

It was developed in the 1970s and has been used to treat vertigo in Japan.

Ifenprodil is an anti-inflammatory agent known as a NMDA receptor antagonist and stops a chain reaction that can make people with COVID-19 very unwell.

Algernon Pharmaceuticals chief Christopher Moreau said it was being looked at for a phase two study on chronic cough in Australia when COVID-19 hit.

"NMDA receptors are present on a number of cells in the body, especially in the lungs and so [we were] interested to see if it could be used to treat other lung diseases," he said.

In animal models with bird flu (H5N1) it increased survivability and reduced lung injury.

Mr Moreau said interim data from its phase two trial was "trending positive" with suggestions fewer COVID-19 patients needed ventilation and a possibility patients were recovering more quickly.

Another use for an old worm treatment

In another small phase one safety study, the clinical research company, the Nucleus Network, is looking at a drug that has been used to treat tapeworms since the 1950s.

South Korean firm Daewoong Pharmaceutical is looking to repurpose the antiparasitic, also known as niclosamide.

It's been turned into a long-acting injection and it's hoped it will prevent the virus from invading host cells by inhibiting a protein called SKP2.

So far it appears to be effective in the lab.

"This one appears to be much more promising [than other antiparasitics] in some ways," principal investigator Dr Paul Griffin said.

"It obviously works on a vastly different pathogen but some drugs have a number of effects."

Buyer beware

Most of these studies are yet to fully report, or report at all, in peer-reviewed journals.

A lot of repurposed drugs have good safety records, but most come with at least some side effects.

Dr Julian Elliott, who runs Australia's National COVID-19 Clinical Evidence Taskforce, said while results could look promising in the lab or animal models they did not always work out in humans.

"We can't make a call really until we have seen the data," he said.

He said the best data always came from large, well-constructed studies.

Dr McMahon said the best treatment for COVID-19 to date had been prevention through masks, social distancing and hand-washing.

"The things that are effective are all the public health measures," he said.

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