Skip to main content Accessibility help
×
Home

Drug Repurposing for COVID-19: Ethical Considerations and Roadmaps

  • HIROYASU INO, EISUKE NAKAZAWA and AKIRA AKABAYASHI

Abstract

While the world rushed to develop treatments for COVID-19, some turned hopefully to drug repurposing (drug repositioning). However, little study has addressed issues of drug repurposing in emergency situations from a broader perspective, taking into account the social and ethical ramifications. When drug repurposing is employed in emergency situations, the fairness of resource distribution becomes an issue that requires careful ethical consideration.This paper examines the drug repurposing in emergency situations focusing on the fairness using Japanese cases. Ethical issues under these circumstances addressed by the authors include: maintaining the evidence level, integrity of clinical research ethics, and voluntary consent by original indication patients. In order to address these issues, they argue that rapid accumulation of ethically and scientifically valid evidence is required, as is obtaining information on resource quantity.

  • View HTML
    • Send article to Kindle

      To send this article to your Kindle, first ensure no-reply@cambridge.org is added to your Approved Personal Document E-mail List under your Personal Document Settings on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part of your Kindle email address below. Find out more about sending to your Kindle. Find out more about sending to your Kindle.

      Note you can select to send to either the @free.kindle.com or @kindle.com variations. ‘@free.kindle.com’ emails are free but can only be sent to your device when it is connected to wi-fi. ‘@kindle.com’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply.

      Find out more about the Kindle Personal Document Service.

      Drug Repurposing for COVID-19: Ethical Considerations and Roadmaps
      Available formats
      ×

      Send article to Dropbox

      To send this article to your Dropbox account, please select one or more formats and confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your <service> account. Find out more about sending content to Dropbox.

      Drug Repurposing for COVID-19: Ethical Considerations and Roadmaps
      Available formats
      ×

      Send article to Google Drive

      To send this article to your Google Drive account, please select one or more formats and confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your <service> account. Find out more about sending content to Google Drive.

      Drug Repurposing for COVID-19: Ethical Considerations and Roadmaps
      Available formats
      ×

Copyright

This is an Open Access article, distributed under the terms of the Creative Commons Attribution licence (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted re-use, distribution, and reproduction in any medium, provided the original work is properly cited.

Footnotes

Hide All

Acknowledgment: This study has been supported by The Mitsubishi Foundation

Footnotes

References

Hide All

Note

1. WHO. Virtual press conference on COVID-19. March 11, 2020; available at https://www.who.int/docs/default-source/coronaviruse/transcripts/who-audio-emergencies-coronavirus-press-conference-full-and-final-11mar2020.pdf (last accessed 14 March 2020).

2. Chong, CR, Sullivan, DJ. New uses for old drugs. Nature 2007;448(7154):645–6. See also, Nosengo, N.Can you teach old drugs new tricks? Nature 2016;534(7607):314–6. See also, Ashburn, TT, Thor, KB. Drug repositioning: Identifying and developing new uses for existing drugs. Nature Reviews Drug Discovery 2004;3(8):673–83.

3. WHO. An R&D Blueprint for Action to Prevent Epidemics: Funding & Coordination Models for Preparedness and Response; 2016 May; available at https://www.who.int/blueprint/what/improving-coordination/workstream_5_document_on_financing.pdf (last accessed 14 March 2020).

4. Chu, CM. Role of lopinavir/ritonavir in the treatment of SARS: Initial virological and clinical findings. Thorax 2004;59:252–56.

5. Arabi, YM, Asiri, AY, Assiri, AM, Aziz Jokhdar, HA, Alothman, A, Balkhy, HH, et al.Treatment of Middle East respiratory syndrome with a combination of lopinavir-ritonavir and interferon-β1b (MIRACLE trial): Study protocol for a randomized controlled trial. Trials 2018;19:81. See also, Sheahan, TP, Sims, AC, Leist, SR, Schafer, A, Won, J, Brown, AJ, et al.Comparative therapeutic efficacy of remdesivir and combination lopinavir, ritonavir, and interferon beta against MERS-CoV. Nature Communications 2020;11:222.

6. Huang, C, Wang, Y, Li, X, Ren, L, Zhao, J, Hu, Y, et al.Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China. The Lancet 2020;395(10223):497506. See also, Nikkei. Shin-gata haien, kou-HIV-yaku touyo-go ni syojo kaizen [2019-nCoV pneumonia has improved after anti-HIV drugs was given]. 2020 February 6; available at https://www.nikkei.com/article/DGXMZO55341640W0A200C2CC1000/ (last accessed 14 March 2020). See also, Reuters. Cocktail of Flu, HIV Drugs Appears to Help Fight Coronavirus: Thai Doctors; 2020 February 2; available at https://www.reuters.com/article/us-china-health-thailand/cocktail-of-flu-hiv-drugs-appears-to-help-fight-coronavirus-thai-doctors-idUSKBN1ZW0GQ (last accessed 14 March 2020).

7. Li G, De Clercq E. Therapeutic options for the 2019 novel coronavirus (2019-nCoV). Nature Reviews Drug Discovery; 2020 February 10; available at https://www.nature.com/articles/d41573-020-00016-0 (last accessed 14 March 2020).

8. Shanghai Institute of Materia Medica, Chinese Academy of Sciences. A Group of Old and Traditional Chinese Medicines that May have a Therapeutic Effect on New Pneumonia; 2020 January 25; available at http://www.simm.ac.cn/xwzx/kydt/202001/t20200125_5494417.html (last accessed 29 Jan 2020).

9. Harrison C. Coronavirus puts drug repurposing on the fast track. Nature Biotechnology; 2020 February 27; available at https://www.nature.com/articles/d41587-020-00003-1 (last accessed 14 March 2020). See also, Fletcher ER. Over 30 antiviral drugs being tested against novel coronavirus: As WHO Convenes Global Innovation Forum. Health Policy Watch; 2020 February 10; available at https://www.healthpolicy-watch.org/over-30-antiviral-drugs-being-tested-against-against-novel-coronavirus-as-who-convenes-global-innovation-forum/ (last accessed 11 March 2020).

10. Emanuel EJ, Persad G, Upshur R, Thome B, Parker M, Glickman A, et al. Fair allocation of scarce medical resources in the time of Covid-19. The New England Journal of Medicine; 2020 March 23; available at https://doi.org/10.1056/NEJMsb2005114 (last accessed 14 March 2020).

11. Iwabuchi K, Yoshie K, Kuraue Y, Takahashi Y, Kato Y, Morishima T. et al. COVID-19 haien syoki kara chuki ni sikuresonido kyunyu wo siyou si kaizen sita 3 rei [Three Cases of Recovery from Early to Middle COVID-19 Pneumonia after Inhaling Ciclesonide]; 2020 March 2; available at http://www.kansensho.or.jp/uploads/files/topics/2019ncov/covid19_casereport_200302_02.pdf (last accessed 12 March, 2020).

12. m3. COVID-19 heno sikuresonido, ippan rinsyo de siyou muzukasii 2 tu no riyu. [2 Hard Issues Prevent Using Ciclesonide for COVID-19 in Clinical Settings] m3; 2020 March 6; available at https://www.m3.com/clinical/news/735718 (last accessed 12 March 2020).

13. The Japan Association for Infectious Diseases. Sikuresonido siyo-jo no go-chui [Precautions for the Usage of Ciclesonide]; 2020 March 16; available at http://www.kansensho.or.jp/uploads/files/topics/2019ncov/covid19_note_ciclesonide.pdf (last accessed 12 March 2020).

14. De Vrieze J. Can a century-old TB vaccine steel the immune system against the new coronavirus? Science; 2020 March 23; available at https://www.sciencemag.org/news/2020/03/can-century-old-tb-vaccine-steel-immune-system-against-new-coronavirus (last accessed 12 March 2020).

15. Sakamaoto N. BCG Korona ni yuuko? Kasetsu de otona no sesshu-kibo kyuzo. Nyuji he kyoukyu ni eikyo mo [Is BCG vaccine effective for COVID-19? A hypothesis made adults request for vaccination. Impact on supply for infants would be seen]. Nishinippon Shimbun; 2020 April 8; available at https://www.nishinippon.co.jp/item/n/599010/ (last accessed 12 March 2020).

16. The Japanese Society for Vaccinology. Sin-gata korona-uirusu kansensho ni tai-suru BCG wakuchin no kouka ni kan-suru kenkai [An Opinion for the Effectiveness of BCG Vaccine against COVID-19]; 2020 April 3; available at http://www.jsvac.jp/pdfs/kenkai.pdf (last accessed 4 April 2020).

17. World Health Organization. Combined Global Demand Forecasts for Antiretroviral Medicines and HIV Diagnostics in Low- and Middle-Income Countries from 2015 to 2020; 2016 September; available at https://apps.who.int/iris/bitstream/handle/10665/250088/9789241511322-eng.pdf (last accessed 12 March 2020).

18. Wang, M, Cao, R, Zhang, L, Yang, X, Liu, J, Xu, M, et al.Remdesivir and chloroquine effectively inhibit the recently emerged novel coronavirus (2019-nCoV) in vitro. Cell Research 2020;30:269–71.

19. Shin-gata inhuruenza-tou oyobi tori-inhuruenza-tou ni kan-suru kankei syocho taisaku kaigi. Shin-gata inhuruenza-tou taisaku gaidorain [Guideline of countermeasures for new types of influenza and other emerging diseases]. Cabinet Secretariat; 2013 June 26; available at https://www.cas.go.jp/jp/seisaku/ful/keikaku/pdf/h300621gl_guideline.pdf (last accessed 14 February 2020).

20. FUJIFILM Toyama Chemical Co., Ltd. Avigan-jyo 200 mg; 2019 April; available at http://fftc.fujifilm.co.jp/med/abigan/pack/pdf/abigan_package_01.pdf (last accessed 14 February 2020).

21. See note 18, Wang et al. 2020.

22. Mill, JS. On liberty. In: Robson, JM and Brady, A, eds. Essays on Politics and Society. Toronto, Buffalo: University of Toronto Press; 1977, at 213310.

23. Zhang, L, Chow, EPF, Jing, J, Zhuang, X, Li, X, He, M, et al.HIV prevalence in China: Integration of surveillance data and a systematic review. The Lancet Infectious Disease 2013;13:955–63.

24. Public Health England. Guidance: COVID-19: Investigation and Initial Clinical Management of Possible Cases; available at https://www.gov.uk/government/publications/wuhan-novel-coronavirus-initial-investigation-of-possible-cases/investigation-and-initial-clinical-management-of-possible-cases-of-wuhan-novel-coronavirus-wn-cov-infection (last accessed 12 March 2020).

25. Chinese Clinical Trial Registry. A Randomized, Open-Label, Blank-Controlled Trial for the Efficacy and Safety of Lopinavir-Ritonavir and Interferon-Alpha 2b in Hospitalization Patients with Novel Coronavirus Infection. Chengdu, China: Ministry of Health (China), 2020. Identifier ChiCTR2000029308; available at http://www.chictr.org.cn/showproj.aspx?proj=48684 (last accessed 29 Jan 2020).

Acknowledgment: This study has been supported by The Mitsubishi Foundation

Keywords

Drug Repurposing for COVID-19: Ethical Considerations and Roadmaps

  • HIROYASU INO, EISUKE NAKAZAWA and AKIRA AKABAYASHI

Metrics

Full text views

Total number of HTML views: 0
Total number of PDF views: 0 *
Loading metrics...

Abstract views

Total abstract views: 0 *
Loading metrics...

* Views captured on Cambridge Core between <date>. This data will be updated every 24 hours.

Usage data cannot currently be displayed.