A global team of scientists have identified 21 existing drugs that stop the replication of SARS-CoV-2, the virus that causes COVID-19.

 A study published in the journal Nature said that four of these compounds were determined to work synergistically with Remdesivir, a current standard-of-care treatment for Covid-19, 

“Remdesivir has proven successful at shortening the recovery time for patients in the hospital, but the drug doesn’t work for everyone who receives it. That’s not good enough,” said senior author of the study Sumit Chanda, Professor at Sanford Burnham Prebys Medical Discovery Institute in California, US.

“As infection rates continue to rise in America and around the world, the urgency remains to find affordable, effective, and readily available drugs that can complement the use of Remdesivir, as well as drugs that could be given prophylactically or at the first sign of infection on an outpatient basis.”

In the study, the research team performed extensive testing and validating studies, including evaluating the drugs on human lung biopsies that were infected with the virus.

They also evaluated the drugs for synergies with Remdesivir and established dose-response relationships between the drugs and antiviral activity.

Out of the 21 drugs that were effective at blocking viral replication, the scientists found 13 have previously entered clinical trials for other indications and are effective at concentrations, or doses, that could potentially be safely achieved in Covid-19 patients.

Two are already approved by the US Food and Drug Administration: Astemizole (allergies), Clofazamine (Leprosy), and Remdesivir have received the emergency use authorization from the agency (Covid-19).

Four of which worked synergistically with Remdesivir, including the Chloroquine derivative Hanfangchin A (Tetrandrine), an antimalarial drug that has reached Phase 3 clinical trials.

 “This study significantly expands the possible therapeutic options for Covid-19 patients, especially since many of the molecules already have clinical safety data in humans,” said Chanda.

 “This report provides the scientific community with a larger arsenal of potential weapons that may help bring the ongoing global pandemic to heel.”

 The researchers are currently testing all 21 compounds in small animal models and “mini lungs,” or lung organoids, that mimic the human tissue.

 If these studies are favorable, the team will approach the US FDA to discuss clinical trials evaluating the drugs as treatments for Covid-19.

 “Based on our current analysis, Clofazimine, Hanfangchin A, Apilimod, and ONO 5334 represent the best near-term options for an effective Covid-19 treatment,” said Chanda.

 “While some of these drugs are currently in clinical trials for Covid-19, we believe it’s important to pursue additional drug candidates so we have multiple therapeutic options if SARS-CoV-2 becomes drug-resistant.”

 These drugs were first identified by high-throughput screening of more than 12,000 drugs from the ReFRAME drug repurposing collection — the most comprehensive drug repurposing collection of compounds that have been approved by the FDA for other diseases or that have been tested extensively for human safety.