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Early Treatment of COVID-19 Disease: A Missed Opportunity
Jamie I Forrest1,2, Craig R Rayner3,4, Jay J H Park1,2
1Cytel Canada Health Inc., Vancouver, BC, Canada.
Abstract:
Antivirals have demonstrated efficacy in treating other infectious diseases in early stages of disease, reducing morbidity, mortality, and the likelihood of onward transmission. At the time of writing, more than 1900 clinical trials are registered globally to assess the efficacy and safety of candidate therapeutics for COVID-19. The majority of these trials are designed to evaluate the comparative efficacy and safety of candidate therapeutics for the treatment of COVID-19 to prevent death among populations of hospitalized patients with advanced disease. Yet, emerging epidemiological evidence now indicates that the majority of those infected with the SARS-CoV-2, while still infectious, experience minimal or mild disease symptomology. Like HIV and hepatitis C that pioneered treatment as prevention, there is a missed opportunity for trials of early pharmaceutical intervention for COVID-19 disease evaluating not only reductions in morbidity and mortality but also transmissibility. We discuss this clinical research gap within an historical context of viral treatment as prevention for HIV and hepatitis C, and comment on the challenges and opportunities for clinical research of candidate therapeutics for early COVID-19 disease.
Insights
Early antiviral treatment for COVID-19 is a missed opportunity. Research should focus on interventions that reduce not only severe illness but also SARS-CoV-2 transmission.
Area of Science:
- Infectious Diseases
- Virology
- Clinical Research
Background:
- Antiviral treatments can be effective in early stages of infectious diseases, reducing severity and transmission.
- Over 1900 clinical trials for COVID-19 therapeutics are registered globally.
- Most trials focus on hospitalized patients with advanced COVID-19 disease.
Purpose of the Study:
- To highlight the missed opportunity in current COVID-19 clinical research.
- To advocate for trials evaluating early pharmaceutical interventions for COVID-19.
- To discuss the potential of "treatment as prevention" for SARS-CoV-2.
Main Methods:
- Review of existing clinical trial designs for COVID-19 therapeutics.
- Analysis of epidemiological evidence on COVID-19 symptomology.
- Historical context of "treatment as prevention" strategies for HIV and Hepatitis C.
Main Results:
- Emerging evidence shows most SARS-CoV-2 infections cause mild disease.
- Current trial focus is on severe/advanced disease, not early intervention.
- A gap exists in trials assessing early COVID-19 treatment's impact on transmissibility.
Conclusions:
- There is a critical need for clinical trials focused on early COVID-19 treatment.
- Early interventions could reduce morbidity, mortality, and crucially, SARS-CoV-2 transmission.
- Lessons from HIV and Hepatitis C highlight the potential of "treatment as prevention" for COVID-19.
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