COVID-19: Treating mild cases is key in Africa

HEALTH 

All eyes are now turned onto the coronavirus (COVID-19) vaccines, but vaccines alone won't be enough to stop the pandemic and save lives, treatments are just as important, according to African Health Researchers.

For that matter, clinical trials have been launched in 13 African countries including Uganda for mild cases of COVID-19 which is the largest effort of its kind in Africa.

The goal of the trial, which is named ANTICOV is to identify treatments that prevent mild cases from progressing to severe forms of the disease - and thus prevent local health systems from being overwhelmed.

"There is a need for large clinical trials in Africa for COVID-19 to answer research questions that are specific to an African context," said Dr John Nkengasong, Director of the Africa Centres for Disease Control and Prevention.

"African countries have mounted an impressive response so far to COVID-19, and now is the time to prepare for future waves of the disease."

"We welcome the ANTICOV trial led by African doctors because it will help answer one of our most pressing questions: With limited intensive care facilities in Africa, can we treat people for COVID-19 earlier and stop our hospitals from being overwhelmed?" added Dr Nkengasong.

Nathalie Strub-Wourgaft, Director of COVID-19 Response for DNDi said collaboration is the only way to provide robust scientific responses to these research questions.

The clinical trial is being carried out at 19 sites in 13 countries by the ANTICOV consortium, which includes 26 prominent African and global research and development organizations, coordinated by the Drugs for Neglected Diseases initiative (DNDi), an international non-profit drug research and development group with extensive partnerships in Africa.

ANTICOV is ‘adaptive platform trial' that will test the safety and efficacy of treatments in 2,000 to 3,000 mild-to-moderate COVID-19 patients in Burkina Faso, Cameroon, Côte d'Ivoire, the Democratic Republic of Congo (DRC), Equatorial Guinea, Ethiopia, Ghana, Guinea, Kenya, Mali, Mozambique, Sudan, and Uganda.

Adaptive platform trials enable rapid decisions to be made, including adding, continuing, or stopping treatment arms based on an ongoing analysis of results.

Researchers can add new treatments as the trial moves on or remove treatments deemed not to be effective as it moves forward.

Launched on November 24, 2002, the clinical trials dovetail with a marked increase in cases in plenty of countries on the continent.

ANTICOV aims to identify early treatments that can prevent the progression of COVID-19 to severe disease and potentially limit transmission.

It could be compared to the SOLIDARITY trial launched by the WHO in March 2020, but while the SOLIDARITY trial focusses in moderate-to-severe, ANTICOV focusses in mild cases.

According to the researchers, treating mild cases is key in Africa because ICU capacity is not as strong as may be in other developed nations.

The researchers lay emphasis that all eyes are now turned to vaccines, but vaccines alone won't be enough to stop the pandemic and save lives, treatments are just as important.

New treatments will be added to the trial as evidence of their potential for mild-to-moderate cases emerge.

ANTICOV researchers are actively looking to select the most promising treatments from ongoing global scientific efforts with proof of efficacy, in collaboration with the Access to COVID-19 Tools Accelerator (ACT-A) Therapeutics Partnership, co-convened by Unitaid and Wellcome on behalf of the COVID-19 Therapeutics Accelerator.

Among the potential therapeutic options being explored by ANTICOV are medicines currently used to treat malaria, HIV, hepatitis C, parasitic infections, and certain cancers. The goal is to include additional treatment arms in the ANTICOV trial within weeks.

In the initial stages, ANTICOV is focusing on drugs where large-scale randomized clinical trials could provide missing efficacy data in mild-to-moderate patients.

The HIV antiretroviral combination lopinavir/ritonavir and the malaria drug hydroxychloroquine are among the drugs to be studied initially, because there are no large multi-country studies yet about the efficacy of the drug for mild cases.

Hydroxychloroquine remains the standard of care for COVID-19 in 16 African countries. "It is heartening to see so many African countries collaborate to get much-needed answers about our unique COVID-19 patient needs," said Dr Borna Nyaoke-Anoke, Senior Clinical Project Manager at DNDi.

"Africa has, for the most part, avoided the large-scale mortality seen in other countries, but with lockdowns ending and borders opening, we need to be prepared."

"We need research here in Africa that will inform policies and test-and-treat strategies, so that as clinicians we can give the best options to people with COVID-19," added Dr Nyaoke-Anoke.

The ANTICOV trial will provide key evidence to inform health policies and national guidelines.