Coronavirus: update on ongoing clinical trials

Text by: Caroline Lachowsky | Ophélie Lahccen

While half of humanity is in containment to slow down the coronavirus pandemic, several teams around the world are mobilized to carry out clinical trials against Covid-19 in record time.

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Professor Bruno Lina is a researcher at the International Center for Research in Infectious Disease at Claude-Bernard-Lyon-1 University; Éric Delaporte is Professor of Infectious Diseases, Director of the “HIV-AIDS and Associated Diseases” unit at the IRD (Research Institute for Development), Inserm and the University of Montpellier . Both were guests of the Health Priority program on Wednesday April 8th, live on RFI.

RFI: Professor Lina, you have an overview of research and clinical trials carried out around the world, and in particular Discovery trials, coordinated by Inserm. Some have already started in your Croix-Rousse hospital in Lyon. How many clinical trials are in progress?

Prof Bruno Lina: There are many clinical trials underway in France and abroad. In China alone, in the first two months, 92 clinical trials were carried out. We see that there is a considerable effort being made to try to understand the disease and find treatments that can reduce the symptoms and, of course, the mortality from this virus. As for Discovery, the trial started almost three weeks ago. It's really a trial that works very well since we have almost 600 inclusions, which is extremely fast for this type of clinical trial. I remind you that there are several tests that are done on drugs such as the one on remdesivir, which is a specific antiviral that must block the entry and replication of the virus in the cell. It really was developed specifically for this virus and tested fairly quickly. There are products that we have reused:

• Lopinavir-Ritonavir which is called Kaletra, which is an anti-HIV
• hydroxychloroquine
• a combination of the anti-HIV product and interferon

Which do you think are the most promising ?

We will have, probably within ten days, the first results on all of these tests to see if there is something looming. Is it observed that certain patients treated with such or such test, present a more favorable evolution than others? We still need about ten days to be able to have the first data to communicate. In addition to the Discovery trial, there are other clinical trials that revolve around what is called immunotherapy and the control of the inflammatory response.

So are you focusing on how the body responds to this virus ?

Prof Bruno Lina: Exactly. We realized that in this disease there is a cytokine cascade, a cytokine storm. Cytokines are the proteins of inflammation, which are there to defend us. On the other hand, when they are produced in too large a quantity and there is a control which is no longer done, it becomes aggressive for our organism. We are trying to modulate this response in such a way that the cytokines keep this activity to fight against the virus but that they lose this danger to our organism. There are first results that should come out in two or three days on anti-interleukins for serious forms which could be interesting.

There is another part of immunotherapy, which is also being evaluated. This is the use of plasma from convalescent patients. When you are healed, it means that you have developed antibodies. These antibodies can be taken from an individual to transfer them to someone who needs them, who does not develop them well. The easiest way to do this is to take plasma (the blood of a healed person), purify it, and pass it on to someone who needs plasma and antibodies to heal. So it can help with healing.

The other thing is the specific research to find these immunoglobulins, to identify them and then to be able to synthesize them in order to be able to do real immunotherapy with monoclonal antibodies. The research field is extremely rich!

Often people say that we are not going fast enough. The epidemic started two months ago. We are already evaluating drugs and treatments. We are certainly going slower than the virus but we are still going very fast.

Professor Delaporte, with regard to the South in general, and Africa in particular, where you are working, are there any avenues to favor in research and clinical trials?

Prof. Eric Delaporte : There are not really any specific tracks for Africa. The virus is universal and so is the fight. Everything that is sought from Asia and the North also benefits the South. On the other hand, there will no doubt be specifics in terms of care and sometimes the approach. There is very important research on the viral track. However, it is a viral but also an immune disease. So there is going to be research to control the messy immune response that creates lung damage.

There are very interesting things that can be directly applied in the South. For example, there is a recent study which shows that the use of corticosteroids in very serious forms, could decrease mortality. There is also research around care that can be directly adapted to contexts in the South.

A very important element, perhaps even more in the North than in the South, will be the availability of medicines. Once we have found a treatment prototype, we will have to make sure that it is available and that it can be effective. This explains the success of hydroxychloroquine. For the first time, there is hope through this drug. We speak of hope because we do not yet have objective elements to say whether it works or not. He has the strength to be available. This is also the case for the antiretroviral Lopinavir-Ritonavir (Kaletra). If these tracks were to work, it would be quite extraordinary to have a drug in real time that was available to affected patients at the same time.

Our selection on SARS-CoV-2 coronavirus

• Listen to Coronavirus Info , daily chronicle on the pandemic

• Explanation: The origins of the Covid-19

• Analysis: What strategies in the face of the Covid-19 epidemic?

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→ How to make a mask and use it well
→ How do you treat Covid-19 patients ?
→ How the Institut Pasteur hopes to find a vaccine

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