Asher Mullard
The Lancet, 2020
The coronavirus disease 2019 (COVID-19) drug pipeline is not growing at quite the same speed as the pandemic. But its rate of expansion is nevertheless cause for pause. In the months since COVID-19 has spread, researchers have launched more than 180 clinical trials of everything from repurposed antivirals and immunomodulators to unproven cell therapies and vitamin C. A further 150 trials are preparing to recruit patients. For pandemic preparedness experts, this begs crucial questions. “Do we need 300 trials? Is that a good use of resources?” asks Daniel Bausch, director of the UK Public Health Rapid Support Team and infectious disease expert at the London School of Hygiene & Tropical Medicine. “I would probably say we don’t.” There are good reasons to build up a full pipeline of COVID-19 drugs. Up to 90% of new entrants into clinical trials never make it to approval, and so investigators want to have as many shots on goal as possible. Scientific understanding of COVID-19 is also changing so quickly that it makes sense to keep options open. But other motives, including public relations and financial gain, might also be in play. “During a crisis, some people will go out of their way to sacrifice their lives, and others will hoard medicines and be complete jerks. On institutional levels, we have the same span of good actors and bad actors”, says Bausch. And in the absence of compre hensive trial coordination mechanisms, signs of disarray are emerging. “The scale of these trials is too small, and the variation in terms of how they are being run is too large”, says John-Arne Røttingen, chief executive of the Research Council of Norway and proponent of a more collaborative approach. “These trials aren’t really designed to answer the questions that need to be answered.” Clinical trial literature, moreover, is riddled with drugs that looked promising in small trials only to prove ineffective in bigger, more rigorous studies.
Cited by 20 publications.
Field of study: Medicine