The most promising therapeutics for COVID-19

17 May 2020

This rapid research brief synthesises the evidence on the most promising COVID-19 therapeutics in development globally and nationally, their mechanisms of action, their stage of development and their strengths and limitations.

Key findings:

  • 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reduces time to recovery in a large study with over 1,000 participants, but the full report of this trial is as yet unpublished.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.

Contributing authors
Lead author: Professor Sharon Lewin AO FAHMS
Lead author: Professor Sharon Lewin AO FAHMS Director, Doherty Institute; Professor of Infectious Diseases, University of Melbourne; Consultant Infectious Diseases Physician, Alfred and Royal Melbourne Hospitals
Professor David Copolov AO
Professor David Copolov AO Prof Vice-Chancellor (Major Campuses and Student Engagement), Monash University
Professor Brendan Crabb AC FAHMS
Professor Brendan Crabb AC FAHMS Director and CEO Burnet Institute
Professor Andrew Cuthbertson AO FAA FTSE FAHMS
Professor Andrew Cuthbertson AO FAA FTSE FAHMS Chief Scientist, CSL Limited
Professor Peter Doherty AC FAA FRS FAHMS Nobel Laureate
Professor Peter Doherty AC FAA FRS FAHMS Nobel Laureate University of Melbourne
Professor Wendy Hoy AO FAA
Professor Wendy Hoy AO FAA Director Centre for Chronic Disease, University of Queensland
Professor Anthony Kelleher FAHMS
Professor Anthony Kelleher FAHMS Program Head – Immunovirology and Pathogenesis Program, Kirby Institute
Dr Suman Majumdar
Dr Suman Majumdar Deputy Program Director, Health Security, Burnet Institute
Image of Professor Gilda Tachedjian
Professor Gilda Tachedjian Head, Life Sciences Discipline, Burnet Institute and President, Australasian Virology Society
Peer reviewers
Professor James McCarthy FAHMS
Professor James McCarthy FAHMS Director, Victorian Infectious Diseases Service, Royal Melbourne Hospital and Professor of Infectious Diseases, University of Melbourne at the Doherty Institute
Professor Paul Myles FAHMS
Professor Paul Myles FAHMS Director, Department of Anaesthesiology and Perioperative Medicine, Alfred Hospital and Monash University
Professor Marc Pellegrini FAHMS
Professor Marc Pellegrini FAHMS Joint Division Head, Infectious Diseases and Immune Defence, Walter and Eliza Hall Institute of Medical Research
Professor Steve Webb FAHMS
Professor Steve Webb FAHMS Senior Staff Specialist in Intensive Care, University of Western Australia; Professor of Critical Care Research, Monash University

© 2020 Australian Academy of Science