Getting a new drug on the market can sometimes take more than a decade. And that’s why already existing drugs are being used in hundreds of clinical trials around the world, and in Boston, seeking a treatment for COVID-19.
Several Boston area hospitals are doing such trials with patients to test antiviral drugs — like one made for Ebola and another for influenza. At Boston University’s National Emerging Infectious Disease Laboratories (NEIDL), researchers are quickly screening thousands of more familiar drugs to see if any might hold promise against COVID-19.
“The most sensible thing to do when you're dealing with a pandemic like this is to try and take what you already have on the shelf and see if it works,” said microbiologist Robert Davey, who leads the research team at BU's NEIDL that specializes in screening pre-existing drugs.
Davey and his team are starting with a library of some 6,800 FDA approved drug compounds from the Broad Institute's Drug Repurposing Hub. These are all small molecule drugs — relatively inexpensive to produce and manufacture on a large scale. Many of them might be found in the average medicine cabinet.
“They’re cholesterol, they’re blood pressure, diabetes treatments, they’re headache treatments, migraines treatments, anything you can imagine,” said Davey.
His team usually works with viruses like Ebola, more deadly than SARS-CoV-2, the virus that causes COVID-19. It’s work that requires wearing special biocontainment suits that include a space-like helmet to seal out any dangerous pathogens. Although such a specialized lab, known as Biosafety Level 4 (BSL4), wasn’t required for work with the novel coronavirus, Davey says the existing lab was able to pivot quickly.
“Because I specialize in finding small molecule drug treatments, I said, 'Well, if I'm going to make the best impact on the pandemic, I should use the resources and the training of my staff and my equipment,'” he said. “That happens to be a BSL 4.”
The lab is working with live virus grown from a sample taken from the first recorded U.S. COVID-19 patient — a man in Washington. The lab researchers then see what effect drug compounds are having on virus-infected human lung cells. This process may eventually screen as many as 20,000 drug compounds.
“It's like finding us a very small key to fit in a lock. And if that key fits just right into the lock,” Davey said, “you're gumming up its works when that key goes into the lock of the virus and it can't make more viruses.”
While it’s possible they might find “the needle in a haystack” — a single drug to treat COVID-19 — Davey said it’s more likely they’ll find drugs with only a partial “hit” against the virus. A combination of drugs will likely be required.
“You then take those things that fit moderately well,” Davey said, “stop the virus reasonably well and you improve them through chemistry.”
Among the many drugs being tested by this lab is one made familiar by President Trump — hydroxychloroquine. Trump has advocated for the use of hydroxychloroquine to treat the virus, and has told the public, “What do you have to lose?” Medical experts and scientists have warned against it. It’s a drug used to treat malaria and lupus, but so far unproven for treating COVID-19 and with potentially deadly side effects.
“There's real risk to taking drugs like that that can tip you over and kill you,” said Arthur Caplan, director of the Division of Medical Ethics at NYU's Langone Medical Center. He also points out that the rush to buy hydroxychloroquine has created shortages for patients who need the drug for its proven uses.
“It's unethical in the extreme to take medicines known to work for people and divert them for long shot efforts to hope that something might happen,” Caplan said.
Careful testing like what’s underway in the BU lab also helps weed out those who are looking to make a quick buck.
“Despite being in desperate times, a lot of people would like to think, 'Yeah, I have an agent that the world's going to take, and I’ll make a fortune from it,'” Caplan said, “If you don't put science first, you're going to have the risk that ... greed might replace evidence.”
Gathering evidence with scientific rigor takes time, but in this crisis, Davey said, he was able to get up and running at “unprecedented speed” — three weeks instead of six months. It's a feat he said was possible only through collaboration among the many research institutions in Boston, as well the accelerated work of the Boston Public Health Commission.
Davey called it “the beauty of Boston.”
“I'm not saying that I'm going to solve this,” Davey said, “but we need many shots at goal. And there are many good groups around the country that can contribute to fight to hopefully scoring that goal. I just felt we needed to be part of that.”