African Research Institutions To Manufacture Own Anti-Covid Drug

By John Ogulei


The ANTICOV clinical trial, conducted in 13 African countries, has started the recruitment of participants to test a new drug to treat Africans with mild-to-moderate COVID-19.


The drug which is a combination of nitazoxanide and ciclesonide is to be used to treat cases before they become severe.


The  ANTICOV  study  is  being  carried  out  by  a  consortium  of  26  partners  which  include  leading  African research institutions and international health organizations. It is being coordinated by the non-profit research and development (R&D) organization Drugs for Neglected Diseases initiative (DNDi).


It is the largest trial in Africa to identify early COVID-19 treatments that can prevent progression to severe disease and potentially limit transmission.


“In many  African countries our worst  fears  are  being  realised,  as already-strained Intensive  Care  Units  are  beginning to fill up with COVID-19 patients,” said Dr. John Nkengasong, Director of the Africa Centres for Disease Control and Prevention (Africa CDC) in a statement to the media.


“Yet the number of vaccine doses that are reaching the African continent is too limited.  The rapid spread  of  new  variants  also  threatens to reduce  the efficacy of existing vaccines, which  is  another  major  cause  for  concern. We  need  urgently  to  identify  affordable  and  easy-to-administer treatments that  can  prevent  the  evolution  to a severe form  of  the  disease and slow the rate of infection,” he added.


The Africa CDC has recorded more than 120,000 deaths from COVID-19 on the continent; however, the true toll is estimated to be higher. And with new variants spreading, an increase in new cases is expected in the coming months.


However, ANTICOV is testing a new potential treatment that combines the well-known antiparasitic nitazoxanide and the inhaled corticosteroid ciclesonide.


The combination has two different mechanisms of action that could work at different stages of infection: one that is potentially active during the first, viral replication stage of SARS-COV-2 infection and one that decreases the likelihood of an inflammatory stage that can start a few days later, according to Dr. Nkengasong.


Both  drugs  are  already commercially  available  and  will  be  affordable  and  easy  to  access and administer, if shown to be effective against COVID-19.


“It has been more than a year since COVID-19 was declared a pandemic, and while we have vaccines registered for use, there are still very few treatment options – especially for the early stage when we could prevent severe progression, potentially reduce transmission, and maybe prevent the risk of developing post-COVID conditions,” said  Dr.  Nathalie  Strub-Wourgaft,  Director  of  the  COVID-19  Response  for  DNDi.


The inclusion of the nitazoxanide + ciclesonide combination in a new arm of the ANTICOV study has been reviewed through the WHO created African Vaccine Regulatory Forum (AVAREF) which facilitated the regulatory  process  in  each  ANTICOV  country and  by  the  WHO  COVID-19  Research Ethics  Review  Committee.


“In addition to treatment options for patients with mild-to-moderate COVID-19, we also need a simple, easy-to-use,  affordable, and  reliable  test  that  can  be  the  backbone  of  test-and-treat programmes led  by  African  governments,” said Dr Monique Wasunna, Director of the DNDi Africa regional office.


The first participants in the new study are expected to be recruited in the Democratic Republic of Congo (DRC) and the Republic of Guinea. In the coming weeks, additional trial sites will enroll participants in Burkina Faso, Cameroon, Côte d’Ivoire, Equatorial Guinea, Ethiopia, Ghana, Kenya, Mali, Mozambique, Sudan, and Uganda.


“As  we  face  a  mutating  virus  that  challenges  the  tools  we  have  to  fight  COVID-19,  research  into  promising  treatments has never been more important. It is vital to work out which therapeutics we can add to the existing package of patient care – and how they can be best-adapted for use in low-resource settings,” said Dr Philippe Duneton, Executive  Director  of  Unit aid,  which  is  partly  funding  the  study.


“Through the ANTICOV trial, Unitaid is investing in potential drugs to treat mild and moderate COVID-19 – a key gap in current treatment options that we must bridge to prevent hospitalisations and deaths.”


ANTICOV is an ‘adaptive platform’ trial, a flexible and innovative trial design that allows for treatments to be added or removed as new evidence emerges.


The trial started in September 2020 with the HIV antiretroviral combination lopinavir/ritonavir and the malaria drug hydroxychloroquine.


These two initial arms were suspended in December 2020 after WHO updated  its  treatment  guidelines to  recommend against  the  use  of  these  drugs  to  treat  COVID-19  patients,  including  patients  with  mild-to-moderate COVID-19.


The ANTICOV Consortium is now in the process of selecting and preparing the next arm of the trial. The selection of trial drugs for ANTICOV is informed by reviews conducted by the expert working group of the Unit aid and Well come-led Access to COVID-19 Tools Accelerator (ACT-A) Therapeutics Partnership.


Major funding for the ANTICOV consortium is provided by the German Federal Ministry of Education and Research  (BMBF)  through KfW and  by  the  global  health  agency Unit aid as  part  of ACT-A. Additional support comes from the European & Developing Countries Clinical Trials Partnership (EDCTP) – under its second   programme   supported   by   the   European   Union   with   additional funding from the Swedish government – the Starr International Foundation and the Stavros Niarchos Foundation (SNF).

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