Four months into the Covid-19 pandemic, scientists and small and large drug makers worldwide are scrambling to come up with drugs that could prove effective against the virus. However, it is still unclear which drugs could combat the viral disease and which will not.
One of the most talked-about possible drugs to treat the coronavirus is a readily available anti-parasitic drug called Ivermectin. According to a study posted on 3 April in the US journal Antiviral Research entitled “The FDA-approved drug Ivermectin inhibits the replication of SARS-CoV-2 in vitro,” this anti-parasitic drug that is already available around the world was found to kills the virus within 48 hours, referring to the US Food and Drug Administration.
The study, a collaboration led by Monash University’s Biomedicine Discovery Institute (BDI) in Melbourne, Australia, with the Peter Doherty Institute of Infection and Immunity, said that a single dose of Ivermectin could stop the growth of the SARS-CoV-2 virus, another name for the Covid-19 virus, in cell culture and effectively eradicate the genetic material of the virus within 48 hours.
“We found that even a single dose could essentially remove all viral RNA by 48 hours and that even at 24 hours there was a really significant reduction in it,” Monash BDI’s Kylie Wagstaff, who led the study, said in a statement.
Ivermectin, first developed in 1975 and coming into medical use in 1981, is an FDA-approved anti-parasitic drug. It is used as an anthelmintic in veterinary medicine and as a treatment for river blindness. It is widely available due to its inclusion on the World Health Organisation’s (WHO) list of essential medicines and therefore has a potential for repurposing.
“Ivermectin is very widely used and is seen as a safe drug,” Wagstaff said, adding that there was now a need to figure out the dosage to be used on humans.
Meanwhile, chair of the Health and Pharmaceutical Industries Committee of the Egyptian Investors Union Mohie Hafez, who has been researching Ivermectin locally for more than 20 years, told Al-Ahram Weekly that “if they lack the drug experience on human beings, we have tried it, and if they lack the assurance of its being safe, we have checked it and proved its safety portfolio. With regard to raw material, this is also available... We have two factories in Egypt that have been producing the drug locally since 2001.”
It would take only 48 hours to produce the needed quantities for treating nationwide coronavirus patients, Hafez said.
“In 1982, one year after it came into medical use, Ivermectin proved its tremendous ability to kill parasites in animals. Ten years later in 1992, it successfully achieved the same purpose in humans. It has been broadly used on the African continent, where more than two million people have been treated for river blindness and elephantiasis,” he added.
In 1998, Hafez, together with his colleague Abdel-Aziz Al-Taweel, a professor of dermatology, read research saying that some cases treated with the drug were cured of some skin diseases as well. “It was then that we began our research,” he said.
“We got the raw material and asked a drug maker to modify it and then tablets were produced at certain concentrations. A different dosage than what previously was used was reached, and it showed impressive results against certain skin diseases in humans,” Hafez said.
In 1999, Hafez locally registered a patent for the new use of Ivermectin against scabies. Thousands of patients have since been treated with the drug, he noted.
“After the announcement by Monash University that a single treatment of Ivermectin is able to effect a 5,000-fold reduction in the virus at 48 hours in cell culture, I called upon all the state bodies concerned in Egypt to get ready to use it to treat the coronavirus,” Hafez said.
At the same time, hundreds of other clinical trials are underway worldwide to test medications that the WHO has selected and researchers are zeroing in on.
“We commend the researchers around the world who have come together to systemically evaluate experimental therapeutics,” said Tedros Adhanom, director-general of the WHO, in a press briefing in March.
In an attempt to reach “clear, strong evidence” of effective drugs able to treat the new coronavirus, the WHO has launched multi-country clinical trials to test four drug regimens as Covid-19 therapies. Among them are an experimental antiviral drug called remdesivir and the antimalarial drug chloroquine (or the related hydroxychloroquine).
Locally, the Egyptian health authorities are working on research using two drugs, one of the WHO’s recommendations and another Japanese medicine, to monitor their effects on the respiratory disease caused by the new coronavirus.
A week ago, Khaled Abdel-Ghaffar, Egypt’s higher education and scientific research minister, said on television that Egypt had received samples of the Japanese anti-viral flu drug Avigan, approved for manufacture and sale in Japan in 2014.
“A month ago, the Egyptian authorities obtained samples of the drug from the Japanese manufacturer Fujifilm,” Abdel-Ghaffar said, adding that in the coming weeks Egypt would receive another larger batch of Avigan samples, in order to conduct clinical and research trials via the Egyptian National Research Centre (NRC).
Earlier this week, the drug’s manufacturer, the Fujifilm Corporation, announced that Avigan would also begin its first US clinical trials in Massachusetts. According to local news, the Japanese government also plans to triple its stockpile of Avigan, of which there is currently enough to treat around 700,000 people, for use in treating two million Covid-19 patients.
Japan plans to offer the drug for free to at least 20 countries hoping to use it to treat coronavirus patients.
“Avigan works against the virus and affects the process of virus division... as opposed to hydroxychloroquine, which is used against malaria,” said Abdel-Ghaffar, adding that “we are working on research using both drugs to monitor their effects.”
However, there have been fears of side effects with some of the drugs. The New York Times said on 12 April that a small study of chloroquine in Brazil was halted early for safety reasons after coronavirus patients taking a higher dose of chloroquine “developed irregular heart rates that increased their risk of a potentially fatal heart arrhythmia”.
In France, the University Hospital Centre of Nice, one of many hospitals trialing hydroxychloroquine in Covid-19 patients, said in a statement that they had highlighted “a major risk of a very serious incident in a patient, and the treatment was immediately stopped”.
Elsewhere in the US, the Mayo Clinic posted an article on its Website late in March saying that the “hydroxychloroquine drug has the potential to lead to sudden cardiac death in some patients”.
According to the Japanese daily Asahi Shimbun, Avigan cannot be prescribed to pregnant women and those who plan to become pregnant because tests on animals have showed it can result in defective babies. The same caution was echoed by the UK Independent newspaper, as it said on 4 April that the drug could have negative side effects “such as birth defects” in unborn children.
Elsewhere, the US Politico website said that US health officials “have repeatedly rejected Avigan in the United States, despite years of advocacy from Japan and Fujifilm.” It quoted a Trump administration official on 31 March who said “there are a lot of concerns about its [Avigan’s] side effects.”
In South Korea, officials in March declined to use Avigan in the nation’s coronavirus response, warning of insufficient evidence and the risk of “serious side effects”.
Hafez said that Avigan and hydroxychloroquine both showed promising results in treating coronavirus, but that they had side effects. “They both can be considered successful drugs in the treatment of coronavirus, but why should we [in Egypt] not have three drugs instead of two, especially because Ivermectin is safer as it has minor side effects and is cheaper,” he asked.
Ivermectin’s side effects range from headaches and tiredness to muscle pain and nausea, according to the US WebMD and HealthLine medical websites.
“One kg of Ivermectin raw material costs $700, and it alone can treat the total number of coronavirus cases nationwide. Taking into account the fact that it has been produced in Egypt for almost 20 years, the total amount needed for treating all the patients nationwide could be ready in 48 hours,” Hafez concluded.
*A version of this article appears in print in the 16 April, 2020 edition of Al-Ahram Weekly under headline: Hopes for a cure