Leading the Charge
The world is making progress against COVID-19 – and small molecules are on the frontlines
Many different therapeutic avenues for COVID-19 are being tested, but so far small molecules have emerged as the first treatments. In May 2020, the FDA issued emergency use authorization for remdesivir as a treatment for severe COVID-19. The drug has since received similar emergency authorizations in India, Singapore, and the UK. In Japan, the drug has been approved for severe COVID-19 under the brand name Veklury. Remdesivir is a nucleotide analog delivered via injection that, when metabolized, forms remdesivir triphosphate – an inhibitor of SARS-CoV-2 RNA polymerase, which prevents viral replication. Clinical trials for remdesivir are ongoing – but results are promising (1). Gilead also wants to commence new trials for an inhaled formulation that could offer a therapeutic intervention for earlier stages of infection.
In the UK, other trial results suggest that the corticosteroid dexamethasone could help treat critically ill COVID-19 patients. According to the study, the drug could reduce mortality of patients on ventilators and oxygen by around one third and one fifth, respectively (2). The WHO is conducting a meta-analysis to decide whether to include dexamethasone in its COVID-19 clinical guidance, but the drug has already been authorized in the UK for hospitalized COVID-19 patients.
It’s true that we don’t yet know how these treatments will work out in long term. Remdesivir was also previously tested against Ebola – and although early results were promising and safety was established, it was later found to be less effective than monoclonal antibody treatments. But, for now, remdesivir and dexamethasone are first to the fight, highlighting the importance of maintaining innovation and investment in small molecule drug discovery and development.
Biopharmaceuticals and advanced medicines are, of course, also being investigated as potential COVID-19 treatments – but progress is somewhat slower because of the inherent complexity. On the other hand, consider the extensive libraries of small molecule compounds that can be screened for potential; supercomputers are already working overtime in this regard – even NASA has joined the COVID-19 fight (3).
One thing is certain, the future of medicine will not depend on one drug type or a single approach. Small molecules, large molecules, gene therapies, cell therapies, and perhaps new but undiscovered avenues will all play a role.
- Gilead, “Gilead Announces Results From Phase 3 Trial of Remdesivir in Patients With Moderate COVID-19” (2020). Available at bit.ly/3eurEQP.
- WHO, “WHO welcomes preliminary results about dexamethasone use in treating critically ill COVID-19 patients” (2020). Available at bit.ly/2Z3FKSH.
- NASA, “NASA Supercomputers Power COVID-19 Research” (2020). Available at go.nasa.gov/31izSYi.
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