Experts in pharmaceuticals are positive about future virus control

Anders Hallberg, Professor em. of Medicinal Chemistry, Faculty of Pharmacy

The pharmacological toolbox against covid-19 is still limited, but extensive efforts to develop new drugs against coronaviruses make the prognosis for future, effective treatments look promising, states the Royal Swedish Academy of Sciences' expert group in a recent report, summarising the current knowledge about covid-19 and the SARS-Cov-2 virus.

“We have followed and analysed scientific literature of high relevance and quality. In our report we present conclusions, lessons learned and recommendations for future pandemics. In the field where I have been primarily involved: Current and future pharmaceuticals to treat COVID-19, my view is that - in addition to the rapid and successful development of covid-19 vaccines - we can expect significant progress and several new effective drugs in the not too distant future,” says Anders Hallberg, Professor em. of Medicinal Chemistry at the Faculty of Pharmacy.

In the report, the expert group divides the therapeutic approaches into four categories: Using antiviral agents to prevent the virus from multiplying. To help the immune system fight the virus or to stop dangerous over-reactivity via anti-inflammatory drugs and immune modulators. To prevent blood clots with anticoagulant drugs, and to prevent secondary infections via antibiotics.

“In order to effectively deal with viral infections such as covid-19, not only vaccines are required. We also need new, more effective antiviral drugs. Such drugs have great potential during the early stages of the disease while the virus is still actively replicating. During the pandemic, the antiviral remdesivir (Veklury) – originally developed against the Ebola virus – has been approved for use in the EU, but was recently found to be of very limited clinical value,” says Anders Hallberg.

For two years, hundreds of clinical trials of various drugs have been underway in order to determine their effect against covid-19. The vast majority of these were developed to treat other diseases, but relatively large numbers show positive results against SARS-Cov-2. In this category we find molnupiravir (Lagevrio), a drug tailored for alphavirus infections, but is already being used in the UK against moderate and mild cases of covid-19.

“The European Medicines Agency, EMA, recently issued an emergency use authorization for both molnupiravir and Paxlovid, a combination of the protease inhibitor nirmatrelvir and ritonavir, which in completely different ways inhibit viral replication. The fact that these, unlike remdesivir, are taken in tablet form is also a great advantage,” says Anders Hallberg, who welcomes EMA’s decision, although emphasizing that safety and side effects must be further evaluated before these drugs can be definitively approved.

In addition to EMA's decision, the European Commission recently listed ten potential drugs as particularly interesting and urgent to examine in detail, which in case of approval will be available in Europe. Among these, there are antiviral drugs, but also immunomodulatory drugs for the treatment of patients with severe covid-19 and a new antibody directed against a preserved epitope of the spike protein.

“To develop a completely new drug usually takes up to 15 years. Today, we can already see a large number of substances in development to improve treatment of coronavirus infection. In addition to our rapidly accelerating knowledge on how to tailor-make drugs relatively accurately at the molecular level, there is much to suggest that we can, in the foreseeable future, address and combat the new viruses and variants that are expected to affect us considerably faster than today,” says Anders Hallberg.