https://www.wsj.com/articles/as-covid-evolves-treatments-may-prove-as-important-as-vaccines-11613083638?mod=opinion_lead_pos6
New Covid-19 variants are eluding antibody treatments and may render vaccines less effective. To keep up, physicians need a broader arsenal of therapies that the virus can’t easily defeat. But the Food and Drug Administration has authorized precious few treatments for Covid-19, namely Gilead’s antiviral remdesivir and monoclonal antibodies by Regeneron Pharmaceuticals and Eli Lilly. The National Institutes of Health has prioritized monoclonal antibodies—essentially manufactured copies of human antibodies—which have shown promise against other diseases, including cancer.
The rub is that mutations that alter the shape of the spike protein on the surface of the virus—as variants from the U.K., Brazil and South Africa do—can deform the sites to which antibodies bind before they neutralize the virus. Developing new antibody cocktails that target new variants could become a game of Whac-A-Mole.
The good news is that Gilead says remdesivir appears effective against the new strains. It is the only FDA-approved antiviral for Covid-19, and the five-day infusion treatment is limited to hospital patients. Antivirals, which stop viruses from replicating in human cells, are typically most effective early in an illness. So finding other effective antivirals, especially ones that can be prescribed to outpatients, should be a priority.
Antivirals can gum up virus replication in myriad ways. Remdesivir creates a paper jam in the coronavirus’s copy machine so it can’t distribute copies of its genetic code. Scientists at the University of Texas last month published a study in the journal Molecular Cell in which they identified the key mechanism remdesivir uses to inhibit the virus’s replication. That could lead to the creation of more potent and perhaps ingestible drugs.
“What if you could take just one pill and that was all you needed to do?” as study co-author Kenneth Johnson was quoted in a UT press release. “That would make a huge difference in terms of the here and now.”