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This rapid research brief responds to the question: What are the most promising COVID-19 therapeutics in development globally and nationally, and what are their mechanisms of action, their stage of development and their strengths and limitations?
• There are over 200 potential COVID-19 therapeutics being tested in more than 1,100 clinical trials.
• As of 17 May 2020, no therapeutic has been shown to be fully effective.
• Trials investigating therapeutics are still in the early stages and findings should be approached with caution while further data are collected and analysed.
• Remdesivir has captured headlines because of a press release announcing that the drug reduces time to recovery in a large study with over 1,000 participants, but the full report of this trial is as yet unpublished. Hydroxychloroquine and chloroquine are the most tested therapeutics, but there are no completed studies of large randomised trials and there are toxicity concerns when used at higher doses.
• Different therapeutics will be needed for mild disease, severe disease and for complications of the disease. Timing of administration of antivirals also appears to be important. Antivirals are being explored for both therapeutic purposes and prevention.
• Researchers globally, including in Australia, are testing repurposed drugs as well as developing new therapeutics. There are many large-scale and likely definitive international clinical trials underway, with one of these including Australian investigators (REMAP-CAP).
• Given our knowledge derived from developing therapeutics for other RNA viruses such as HIV and hepatitis C, and the intense global effort for COVID-19, it is reasonable to expect a range of effective therapeutics in the next 12-24 months.