The WHO Launches a Global Trial of the Four Most Promising COVID-19 Drugs

The WHO has announced a global trial, called SOLIDARITY, to assess the effectiveness of the four most promising coronavirus treatments currently under investigation:

• Remdesivir, a drug that was originally developed to treat Ebola but lacked effectiveness. It shuts down viral replication by targeting RNA-dependent RNA polymerase, the enzyme used by the coronavirus to copy its genetic material.
• Chloroquine and hydroxychloroquine, antimalarial drugs that have shown some effectiveness in treating COVID-19. The available evidence is limited, however, and the drugs can have serious side effects.
• Ritonavir and lopinavir, an anti-HIV combination drug that inhibits proteases – enzymes that cleave viral proteins and are essential for the completion of the viral life cycle. The drug is relatively safe, but may have serious interactions with other drugs.
• Ritonavir and lopinavir with interferon beta. Interferon beta is an inflammatory regulator that enhances cells’ response to viral infection. It could enhance the effectiveness of antiviral drugs, but could also lead to worsened tissue damage if given too late during the disease.

Confirmed cases of COVID-19 who are eligible can enrol to receive one of the drugs at random. The trial will not be double blind, as the trial seeks to balance scientific rigour with speed. The WHO are also seeking to keep the trial as simple as possible, so that hospitals struggling under a heavy burden of cases can still contribute.

The design of the trial will remain flexible – some drugs may be dropped once they prove to be ineffective, while new drugs could be included.