新型冠状病毒治疗候选药物的系统与临床药理学:从临床与转化医学角度观察
Systems and Clinical Pharmacology of COVID-19 Therapeutic Candidates: A Clinical and Translational Medicine Perspective.
机构信息
Department of Pharmaceutics, School of Pharmacy, Seattle, WA 98195, USA; Targeted and Long-Acting Drug Combination Anti-Retroviral Therapeutic (TLC-ART) Program, University of Washington, Seattle, WA 98195, USA; NanoMath, Seattle, WA 98115, USA.
Department of Pharmaceutics, School of Pharmacy, Seattle, WA 98195, USA; Targeted and Long-Acting Drug Combination Anti-Retroviral Therapeutic (TLC-ART) Program, University of Washington, Seattle, WA 98195, USA.
出版信息
J Pharm Sci. 2021 Mar;110(3):1002-1017. doi: 10.1016/j.xphs.2020.11.019. Epub 2020 Nov 26.
Over 50 million people have been infected with the SARS-CoV-2 virus, while around 1 million have died due to COVID-19 disease progression. COVID-19 presents flu-like symptoms that can escalate, in about 7-10 days from onset, into a cytokine storm causing respiratory failure and death. Although social distancing reduces transmissibility, COVID-19 vaccines and therapeutics are essential to regain socioeconomic normalcy. Even if effective and safe vaccines are found, pharmacological interventions are still needed to limit disease severity and mortality. Integrating current knowledge and drug candidates (approved drugs for repositioning among >35 candidates) undergoing clinical studies (>3000 registered in ClinicalTrials.gov), we employed Systems Pharmacology approaches to project how antivirals and immunoregulatory agents could be optimally evaluated for use. Antivirals are likely to be effective only at the early stage of infection, soon after exposure and before hospitalization, while immunomodulatory agents should be effective in the later-stage cytokine storm. As current antiviral candidates are administered in hospitals over 5-7 days, a long-acting combination that targets multiple SARS-CoV-2 lifecycle steps may provide a long-lasting, single-dose treatment in outpatient settings. Long-acting therapeutics may still be needed even when vaccines become available as vaccines are likely to be approved based on a 50% efficacy target.
已有超过 5000 万人感染了 SARS-CoV-2 病毒,其中约有 100 万人因 COVID-19 疾病进展而死亡。COVID-19 表现出类似流感的症状,大约在发病后 7-10 天,病情可能会恶化成细胞因子风暴,导致呼吸衰竭和死亡。尽管社交距离可以降低传染性,但 COVID-19 疫苗和疗法对于恢复社会经济正常化至关重要。即使找到了有效和安全的疫苗,仍然需要药物干预来限制疾病的严重程度和死亡率。为了整合当前的知识和药物候选物(超过 35 种候选药物的重新定位批准药物),我们正在进行临床研究(ClinicalTrials.gov 上注册了超过 3000 种),我们采用系统药理学方法来预测抗病毒药物和免疫调节剂如何进行最佳评估。抗病毒药物可能仅在感染的早期有效,即在接触后不久且在住院之前,而免疫调节剂应在后期的细胞因子风暴中有效。由于目前的抗病毒候选药物在医院中使用 5-7 天,因此针对多个 SARS-CoV-2 生命周期步骤的长效联合疗法可能会在门诊环境中提供持久的单次剂量治疗。即使疫苗可用,长效疗法仍可能是必要的,因为疫苗可能会基于 50%的疗效目标获得批准。