Three medicines currently being used to treat malaria, cancer and immune deficiencies are being tested on hospitalised patients with COVID-19 to see whether they can be repurposed to address the virus, the World Health Organization (WHO) announced on Wednesday.

“These therapies – artesunate, imatinib and infliximab – were selected by an independent expert panel for their potential in reducing the risk of death in hospitalized COVID-19 patients,” said the WHO.

Artesunate is currently used to treat severe malaria, imatinib treats certain cancers, and infliximab is used against diseases of the immune system, including Crohn’s Disease and rheumatoid arthritis.

The medicines will be tested as part of the next phase of the WHO’s Solidarity trial platform, Solidarity PLUS, which “represents the largest global collaboration among WHO Member States”, according to the global body. 

“The trial involves thousands of researchers at more than 600 hospitals in 52 countries,” WHO Director-General Dr Tedros Adhanom Ghebreyesus told a media briefing on Wednesday.

Finland becomes the first to test the medicines

Hanna Sarkkinen, Finland’s Minister of Social Affairs and Health, told the briefing that two hospitals in her country had become the first in the world to start recruiting patients to test these medicines on 6 August.

“Even though there are approximately 3,000 clinical studies on COVID-19, most of them are too small to yield significant information,” said Sarkkinen, adding that only Solidarity and the United Kingdom’s Recovery trials were large enough to reliably assess multiple new treatments fast and at the same time.

Manufacturers of the drugs have donated stock to Solidarity Plus. 

Artesunate, produced by Ipca, will be administered intravenously for seven days using the standard dose recommended for the treatment of severe malaria.

Novartis’s Imatinib will be administered orally, once daily, for 14 days. Johnson and Johnson’s Infliximab will be administered intravenously as a single dose. 

Dr Ana Maria Henao-Restrepo, head of WHO’s Research and Development Unit, said that two expert groups assisted the WHO to identify promising COVID-19 treatments. 

“We have an independent expert group that helps WHO to review the evidence of all the emerging drugs and treatments that are available. As they become promising based on the data, we consider them for the therapeutics trial, Solidarity Plus,” said Henao-Restrepo.

“In addition, WHO has another independent group of experts that routinely reviews the evidence on drugs for which there is information from Phase Three clinical trials and beyond. This independent committee also helps WHO to formulate the guidelines that will be used to improve or to adjust the current clinical management of patients with COVID,” she added.

“So any drug that has been tested or used through a clinical trial, or through an observational deployment in a country is of interest for us.”

Four targets to treat COVID infection

Dr Mike Ryan, WHO’s Executive Director of Health Emergencies, said that the WHO was looking at four targets to mitigate COVID-19 infections: developing more broad-spectrum antivirals; developing and deploying monoclonal and polyclonal antibodies; knowing how to use steroids and immunomodulators that modulate the immune response, and ensuring people have access to higher standards of care, basic oxygen and intensive care. Previously, Solidarity has tested remdesivir, hydroxychloroquine, lopinavir and interferon, but the trial results showed that they had little or no effect on hospitalized patients with COVID-19.

Meanwhile, the Drugs for Neglected Diseases initiative (DNDi) has warned that the few innovative COVID-19 therapeutics are mostly available in high-income countries, and that the world risks “replicating the vaccine inequality” if these are not shared with low and middle-income countries (LMIC).

To arrest the progress of COVID-19, there is a “clear rationale emerging” that strong antivirals combined with host-directed therapies (anti-inflammatories and immunomodulators) need to be given to patients during the first few days of infection, said DNDi in a new report.“Efforts are today rightly focused on identifying novel antivirals, additional repurposed therapeutics, and more affordable and adapted new approaches, such as second-generation monoclonal antibodies and other biologics,” it adds. 

But, says Rachel Cohen, DNDi’s North America Executive Director, “with more interest now in second-generation monoclonal antibodies and antivirals, the investment going into these areas needs to be directed to the right area, and it must ensure access.”