THE TIME COURSE OF THERAPEUTIC INTERVENTIONS FOR COVID-19
Authors: Ngo Binh T. , Marik Paul , Kory Pierre , Shapiro Leland , Thomadsen Raphael , Iglesias Jose , Ditmore Stephen , Rendell Marc , Griffin Daniel , Varon Joseph , Dubé Michael , Nanda Neha , In Gino , Arkfeld Daniel , Chaudhary Preet , Campese Vito M. , Hanna Diana L. , Sawcer David E. , Ehresmann Glenn , Peng David , Smogorewski Miroslaw , Armstrong April , Dasgupta Rajkumar , Sattler Fred , Mussini Cristina , Mitja Oriol , Soriano Vicente , Peschanski Nicolas , Hayem Gilles , Confalonieri Marco , Piccirillo Maria Carmela , Lobo-Ferreira Antonio , Rivero Iraldo Bello , Havana Cuba , Vinjevoll Eivind H. , Hung Ivan FN 
Published: June 2020

BACKGROUND

The spread of COVID-19 from Wuhan China, has been alarmingly rapid. Epidemiologic techniques succeeded in containing the disease in China, but efforts have not been as successful in the rest of the World, with a total of 29,155,581 confirmed cases of COVID-19, including 926,544 deaths worldwide as of September 15, 2020. Projections are for continued new infections and deaths if no effective therapeutic interventions can be initiated over the next several months. We performed a systematic review to determine the potential time course for development of treatments and vaccines, focusing on availability now and continuing in the last half of 2020.

METHODS

Clinical Trials

We reviewed up-to-date information from several sources to identify potential treatments for COVID-19: The Reagan-Udall Expanded Access Navigator COVID-19 Treatment Hub was used to track the efforts of companies to develop agents. We focused on trials completed as of September 1, 2020 on identified agents We used several different sources: (A) covid-trials.org, then validated results on (B) clinicaltrials.gov and the (C) World Health Organization’s International Clinical Trials Registry Platform (WHO ICTRP). We excluded studies which were clearly observational, with no randomization, control, or comparison group. We further set a cutoff of 100 for numbers of subjects, since smaller trial size could lack statistical power to establish superiority of the intervention over the control.

Publications

We searched for published trial results on pubmed.gov and on medRxiv, the preprint server, and used a targeted Google™ search to find announcements of unpublished trial results

RESULTS

Clinical Trials in Recruitment

As of our cutoff date of April 1, 2020, we found 409 trials meeting our minimum requirement of 100 subjects. The WHO Solidarity megatrial for hospitalized patients was launched in over 100 countries, actively comparing hydroxychloroquine (HCQ), lopanovir/ritonavir (LPV/r) alone and in combination with interferon beta-1, and remdesivir. The LPV/r alone and HCQ arms have already been discontinued. Of these, only 9 were conducted on outpatients. A few vaccine trials are hoping to complete Phase 3 enrollment by the end of the third quarter 2020, but a prolonged follow-up of patients will likely be required.

Clinical trials Completed

As of September 1, 2020, there were 231 trials reporting completion, Of these, only 59 studies enrolled 100 or more subjects. There were 34 trials in hospitalized patients, 9 directed at outpatients, and 8 prevention studies,

Published Data

As of September 1, 2020 we found 70 publications reporting findings in human studies on 13 classes of drugs and on 6 vaccines. There were 33 randomized placebo or active control studies; the rest were retrospective observational. Only seven publications dealt with outpatient care, the rest all in hospitalized patients.

Available Treatments

At this time, remdesivir and convalescent plasma have been granted emergency use authorization in the U.S.A., solely for hospitalized patients. There is also support for glucocorticoid treatment of the COVID-19 respiratory distress syndrome. No treatments or prophylaxis are offered for outpatients.

CONCLUSION

COVID-19 is propagated primarily by infected ambulatory individuals. There have been no options brought forward for prevention and non-hospital treatment with only a few randomized, controlled outpatient studies expected to yield results in time to impact on the continuing pandemic by the end of 2020. It will be necessary for public health authorities to make hard decisions, with limited data, to prevent the continued spread of the disease. The choices will be hardest when dealing with possible early release of safe and effective vaccines which would, of course, be of greatest benefit to the World’s population.