After achieving quick victories in developing COVID-19 vaccines and treatments such as antiviral pills, leading drug manufacturers are shifting their focus to a more elusive target: long COVID.

Drugmakers Play a Key Role

GlaxoSmithKline and other major pharma companies have been engaged in preliminary talks with researchers about how best to approach long COVID, and conducting clinical trials using current experimental long COVID treatments.

The 100 million-plus people living with long COVID worldwide are counting on these companies to repeat their success. Experts say these major drug manufacturers will play a critical role in delivering proven treatments, but this one won’t be an easy task. Now associated with more than 200 afflictions, long COVID has been a moving target.

Atlanta resident Sandi Zack, 53, is one of the estimated 14% of American working-age adults affected by long COVID. Since developing COVID-19 in December 2020, she has lived with extreme fatigue, dizziness, pain, and heart palpitations, despite numerous prior treatment attempts. “We’re all still out here,” she lamented. “Hoping, and waiting.”

Not an Easy Illness to Define or Study

Researcher interviews and a global clinical trial database indicate that there are fewer than 20 treatment studies now underway, with just several advancing beyond the beginning stages. The hope is that new research will identify long COVID’s causes (a stumbling block to finding new treatment targets), or at least reveal existing treatments that may be effective against it.

Current thought on possible causes of long COVID includes the following, singly or in combination:

• Direct viral damage, either during initial infection or through remaining pools of virus
• Autoimmunity, wherein the body’s immune system attacks healthy tissue
• Dysregulated immunity, where a heightened immune response leads to excessive inflammation that can damage small blood vessels and nerves
• Microclots, microscopic blood clots that can cause vascular issues
• Reactivated dormant viral infections not directly related to the SARS-CoV-2 virus

According to post-viral disease expert Dr. Amy Proal of the PolyBio Research Foundation, pharma companies have been “struggling” to devise criteria for determining when a person has long COVID. They also need to find biomarkers that show a test drug is effective and has value.

But University of Exeter Medical School lecturer David Strain says researchers are beginning to gain traction with treatment testing and is hopeful long COVID treatments will be available “in the near future.” Strain’s own research is helping to propel a major British trial.

A Look at Trials Now Underway

Major U.K. study

University College, London, will lead a major U.K.-funded trial involving 4,500 long COVID patients and four existing drugs with promising early data:

• Loratadine (antihistamine)
• Famotidine (antihistamine)
• Colchicine (gout and heart inflammation)
• Rivaroxaban (Xarelto®) (blood clot prevention)

Lead researcher Amitava Banerjee says the trial isn’t easy because the target is “hazy,” but they aim to learn more about possible underlying disease mechanisms.

Help for fatigue, brain fog, and lung scarring?

A drug created for the liver disease nonalcoholic steatohepatitis (NASH), characterized by abnormal metabolism, inflammation, and scar tissue, is being studied for long COVID by Axcella Therapeutics and the University of Oxford. Through the drug, researchers hope to normalize function of mitochondria, where energy is made and which may underlie long COVID fatigue.

Resolve Therapeutics’ experimental long COVID treatment, RSLV-132, is now being tested by the University of Washington and Fred Hutchinson COVID Clinical Research Center for fighting inflammation, fatigue, and brain fog. The drug is designed to remove from circulation certain nucleic acids that promote inflammation in autoimmune disease.

Meanwhile, PureTech Health is midway in developing a treatment to prevent long-term lung scarring (pulmonary fibrosis) from COVID-19.

Lingering virus at the root of long COVID?

Researchers who support the theory of lingering virus behind long COVID are anxious to test existing antiviral treatments and vaccines. Moderna is even donating its vaccine to see whether it can jumpstart immunity in early U.K. long COVID trials.

Funding Also Elusive

Securing funding has also been difficult for some companies, like German biotech company Berlin Cures Holdings AG. Makers of an autoimmune drug previously used in heart failure, the company has only been able to secure funding for early-phase testing.

This doesn’t do much to encourage people living with long COVID. Said Chief Operating Officer Peter Goettel, “People call us and they cry on the phone. Some people want to sell their house to give us donations, just to get a shot.”

*Rigby, J. & Steenhuysen, J. (2022, March 25). Drugmakers, scientists begin the hunt for long COVID treatments. Reuters. https://www.reuters.com/business/healthcare-pharmaceuticals/drugmakers-scientists-begin-hunt-long-covid-treatments-2022-03-25