Drug Repurposing for the Treatment of Severe COVID-19 and the Impact on Disease Outcomes

Purpose: Up to mid-July 2021, 4.095.223 deaths by Coronavirus disease 2019 (Covid-19) had been confirmed worldwide. Nevertheless, due to the lack of a specific pharmacological treatment against Covid-19, drug repurposing has been used for patients’ clinical management. The aim of this study is to identify the most common repurposed drugs used in the first and second waves of the Covid-19 pandemic and their association with clinical outcomes in a large Latin America public hospital.Methods: The study evaluated a cohort of hospitalized patients with a RT-PCR confirmed Covid-19 infection. Adult patients were enrolled during the first (March to July 2020) and second (January to March 2021) Covid-19 waves. All clinical and pharmacological information was retrieved from the medical records.Results: We included 501 patients hospitalized due to Covid-19, of which 267 were admitted to the ward, and 234 to the intensive care unit. We observed that hydroxychloroquine and antivirals were commonly prescribed at the beginning of the pandemic, whereas anticoagulants and glucocorticoids prescriptions became predominant after June 2020. Despite the changing drug repurposing approaches, in-hospital death rates did not improve throughout the study period.Conclusion: Several drug repurposing approaches were applied during the Covid-19 pandemic without substantially affecting the disease fatality rate. The experience in treating Covid-19 patients underscores that drug repurposing does not substitute the need for scientific-based drug development and clinical trials before a therapy is recommended.Funding Information: This study was funded by São Paulo Research Foundation - FAPESP (grant number 20/12630-2). Vaz CO, Mesquita GLTV, dos Santos APR and Jacintho BD receive financial support (scholarship) from São Paulo Research Foundation- FAPESP (grants number: 2020/07922-4; 2019/20320-6; 2019/20891-3; 2019/20136-0 respectively ). Oliveira JD receives financial support from the National Council for Scientific and Technological Development.Declaration of Interests: The authors declare no competing financial interests. Ethics Approval Statement: This study was performed in line with the principles of the Declaration of Helsinki. Approval was granted by the Ethics Committee of University of Campinas – Unicamp (CAAE 30648520.6.0000.5404).