The US may have bought up nearly all of the world’s stocks of remdesivir, but luckily another drug is emerging that looks as though it may be effective — and cheaper — in treating patients with Covid-19.

Four independent studies indicate that baricitinib, which was designed as a rheumatoid arthritis drug, could be effective in preventing the extreme immune system reactions — the cytokine storms — that are often the cause of death for patients ill with Covid-19.

In the largest of the four recent studies, carried by the Hospital of Prato in Italy, 113 patients treated with baricitinib were compared with a control group of 78. Deaths were significantly lower — none of the patients on baricitinib died, compared with five of the control group.

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In the same study, only one had to be admitted to intensive care, compared with 14 of the control group. 88 of the baricitinib patients were discharged from hospital within two weeks, compared with just 10 of the control group.

This and the other three new studies (listed below) only give an early indication of the possible effectiveness of the drug. Baricitinib is being used in 12 clinical trials worldwide, and results from two much larger global trials by the NIAID and Eli Lilly, involving in total some 1200 patients, are expected in six to eight weeks.

But it’s an early sign that the drug might work, which if true would be hugely significant both for the fight against coronavirus and the notion that artificial intelligence could be used to discover new applications for existing drugs.

Baricitinib is widely available — most often used under the brand name Olumiant — and as a result, would likely be cheaper than remdesivir. A 10-day course of remdesivir is expected to cost $2,340 in the US, while the cost of a baricitinib course is expected to be less than $500.

If the drug is proven to be effective, it would also be a huge boost to BenevolentAI, the UK-based AI drug discovery company that initially identified baricitinib as a potential treatment using its machine learning system.

At the beginning of the outbreak UK-based BenevolentAI, which uses machine learning to aid drug discovery, used its “knowledge graph”, a database of all existing, approved drugs, to find one that could be repurposed to treat the novel coronavirus.

“Assuming it works in randomised trials our reputation will be great and some of the sceptics about AI will be silenced,” said Peter Richardson, vice president of pharmacology at BenevolentAI.

AI companies have held out the promise of being able to shorten the development process for new medicines, but are still at the early stages of proving this.

 

Data on baricitinib as potential treatment for COVID-19

Baricitinib restrains the immune dysregulation in COVID-19 patients (data on 20 patients administered baricitinib)
Bronte et al, Department of Medicine, University and Hospital Trust of Verona, Italy
Date: 26 June 2020

Baricitinib therapy in COVID-19: A pilot study on safety and clinical impact (data on 12 patients administered baricitinib)
Journal of Infection
Cantini et al, Rheumatology Department, Hospital of Prato, Italy
Date: 23 April 2020

Use of Baricitinib in Patients with Moderate and Severe COVID-19 (data on 15 patients administered baricitinib)
Clinical Infectious Diseases
Titanji et al, Division of Infectious Diseases, Emory University School of Medicine, Atlanta, Georgia, United States
Date: 29 June 2020

Retrospective, multicenter study on the impact of baricitinib in COVID-19 moderate pneumonia (data on 113 patients administered baricitinib)
Journal of Infection
Cantini et al, Rheumatology Department, Hospital of Prato, Italy
Date: 24 June 2020

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