Outcomes of the UK COVID-19 Therapeutics Advisory Panel (UK-CTAP)

Contents

Recommended treatments for clinical trials

These treatments may not be approved for treating COVID-19. For the latest COVID-19 advice, talk to your GP or visit the NHS website.

About this data

This is the record of treatments recommended by the UK COVID-19 Therapeutics Advisory Panel (UK-CTAP) for clinical trials.

Each recommendation record includes:

  • treatment name
  • the trial recommended for
  • why it was recommended
  • date of recommendation.

This record does not list outcomes for treatments not yet recommended for a clinical trial.

The treatments listed could be:

  • recommended for more than one trial
  • widely used for treating other conditions
  • not yet licensed for treatments but show potential for treating COVID-19
  • formulated in a new way to target the virus.

A treatment may be recommended by the panel but not be entered into a trial.

For more information, see introduction to UK-CTAP.

Treatments recommended for trials

Aspirin

Trial recommended to: RECOVERY+

Date: 1 November 2020

Why it was recommended:

Aspirin decreases the body’s ability to form blood clots. COVID-19 is known to cause clotting problems and serious illness due to extra clots forming in blood vessels, which can lead to organs being starved of blood and oxygen. Aspirin may prevent some deaths or illness by blocking the formation of clots due to COVID-19.

Specifically, aspirin is a nonsteroidal anti-inflammatory drug (NSAID) that inhibits prostaglandin formation and suppresses the normal functioning of platelets.

 

Colchicine

Recommended to RECOVERY+

Date: 17 November 2020

Why it was recommended:

Colchicine has been used for a long time to treat diseases such as arthritis, which have high levels of inflammation. COVID-19 patients have overactive inflammation in their blood and lungs from their response to infection, so colchicine might reduce this in COVID-19.

Specifically, colchicine acts on multiple mechanisms of inflammation including the inflammasome, which is thought to be activated in COVID-19.

 

Favipiravir

Trial recommended to: PRINCIPLE

Date: 17 December 2020

Why it was recommended:

COVID-19 is caused by SARS-CoV-2, a virus that multiplies inside lung and other cells. Favipiravir is an antiviral drug used for influenza and similar viruses.

It works by blocking a key component in the viral machinery necessary for these viruses to multiply, and has been found in laboratory experiments to effectively stop replication of the virus causing COVID-19. It is hoped that favipiravir can reduce virus growth in early infection, therefore making the disease less severe or reducing the number of people who could become infected.

Specifically, favipiravir is a nucleoside analogue that interacts with viral RNA-dependent RNA polymerase in RNA viruses.

 

Baricitinib

Trial recommended to: RECOVERY+

Date: 11 January 2021

Why it was recommended:

In people with severe COVID-19, parts of the immune system are very active, particularly in their lungs and blood, which causes inflammation and organ damage. Baricitinib blocks one of the pathways for inflammation in the body. By reducing the body’s inflammatory response, baricitinib might prevent or reduce the severity of the COVID-19 illness.

Specifically, baricitinib acts on the JAK/STAT pathway, which is a central controller of inflammation thought to be upregulated in COVID-19.

 

Dimethyl Fumarate

Trial recommended to: RECOVERY+

Date: 11 January 2021

Why it was recommended:

In people with severe COVID-19, parts of the immune system are very active, particularly in their lungs and blood, which causes inflammation and organ damage.

Dimethyl fumarate blocks multiple pathways for inflammation in the body. By reducing the body’s inflammatory response, dimethyl fumarate might prevent or reduce the severity of the COVID-19 illness. It is often used in diseases where similar inflammation is an issue.

Specifically, dimethyl fumarate acts on multiple mechanisms of inflammation including the inflammasome, which is thought to be activated in COVID-19.

 

Anakinra

Trial recommended to: RECOVERY+

Date: 1 November 2020

Why it was recommended:

Anakinra has been recommended for the RECOVERY+ trial in children that are affected by a rare inflammatory condition called Paediatric Multisystem Inflammatory Syndrome (PIMS-TS or PIMS), which may be linked to COVID-19. Anakinra is a medicine that is currently licensed for use in adults and children in diseases that are associated with high levels of inflammation, such as arthritis.

Specifically, anakinra binds to the interleukin 1 (IL-1) receptor and thereby reduces inflammatory IL-1 signalling, which might prevent or reduce the severity of PIMS-TS.

 

Niclosamide

Trial recommended to:

  • RECOVERY Phase 2, 23 September 2020.
  • AGILE, 1 February 2021.

Why it was recommended:

Niclosamide is a drug used to treat tapeworm infections that was also found in laboratory experiments to stop the growth of SARS-CoV-2, the virus that causes COVID-19. It comes in multiple forms, for example:

  • inhaled
  • nasal drops
  • oral
  • injection.

Treatment for COVID-19 is based on niclosamide inhibiting both viral growth and inflammation.

Specifically, niclosamide has been found to inhibit TMEM16, a calcium-activated ion channel involved in viral-induced syncytia.

 

Colchicine

Trial recommended to: PRINCIPLE

Date: 1 February 2021

Why it was recommended:

Colchicine has been used for a long time to treat diseases such as arthritis, which have high levels of inflammation. COVID-19 patients have overactive inflammation in their blood and lungs from response to infection, so colchicine might reduce this in COVID-19.

Specifically, colchicine acts on multiple mechanisms of inflammation including the inflammasome, which is thought to be activated in COVID-19.

 

Adalimumab

Trial recommended to: PRINCIPLE

Date: 1 February 2021

Why it was recommended:

Adalimumab is widely used to treat inflammatory diseases such as arthritis. Adalimumab blocks one of the pathways for inflammation in the body. By reducing the body’s inflammatory response, adalimumab might prevent or reduce the severity of the COVID-19 illness.

Specifically, adalimumab inhibits tumour necrosis factor (TNF), a central controller of inflammation thought to be upregulated in COVID-19.

 

Atorvastatin

Trial recommended to: HEAL-COVID

Date: 10 February 2021

Why it was recommended:

Statins are prescribed by doctors to reduce cholesterol, but are thought to have a number of other effects in the body including reducing inflammation and blood clotting. Emerging evidence suggests that these processes are important causes of long-term illness following COVID-19 infection. Therefore, statins might be able to counter some of these effects.

Specifically, statins have pleiotropic effects on multiple pathways relevant to COVID-19 (including anti-inflammatory, anti-thrombotic, antioxidant and immunomodulatory). These drugs have a well-understood safety profile and the benefits are likely seen across the class, but atorvastatin was selected as the optimum choice due to lower likelihood of drug interactions.

 

Apixiban

Trial recommended to: HEAL-COVID

Date: 10 February 2021

Why it was recommended:

Apixiban works on the body’s ability to form blood clots and disrupts their formation. COVID-19 is known to cause clotting problems and serious illness due to extra clots forming in blood vessels, which can lead to organs being starved of blood and oxygen. Apixiban may prevent some deaths or illness by blocking the formation of clots due to COVID-19.

Specifically, apixaban is a potent, oral, reversible, direct and highly selective active site inhibitor of factor Xa. By inhibiting factor Xa, apixaban prevents thrombin generation and thrombus development

 

Namilumab

Trial recommended to: RECOVERY+

Date: 10 February 2021

Why it was recommended:

In patients with severe COVID-19, overactive immune cells cause much of the damage in their lungs. By blocking these cells from multiplying and entering the lung, namilumab may prevent people from developing severe COVID-19.

Specifically, namilumab inhibits GM-CSF, a monocyte and macrophage stimulating factor that causes expansion and differentiation of inflammatory macrophage populations that are over-represented in the lungs of patients with severe COVID-19.

 

Namilumab

Trial recommended to: REMAP-CAP

Date: 12 February 2021

Why it was recommended:

In patients with severe COVID-19, overactive immune cells cause much of the damage in their lungs. By blocking these cells from multiplying and entering the lung, namilumab may prevent people from developing severe COVID-19.

Specifically, namilumab inhibits GM-CSF, a monocyte and macrophage stimulating factor that causes expansion and differentiation of inflammatory macrophage populations that are over-represented in the lungs of patients with severe COVID-19.

 

Infliximab

Trial recommended to: RECOVERY+

Date: 10 February 2021

Why it was recommended:

Infliximab is widely used to treat inflammatory diseases such as arthritis. Infliximab blocks one of the pathways for inflammation in the body. By reducing the body’s inflammatory response, infliximab might prevent or reduce the severity of the COVID-19 illness.

Specifically, infliximab inhibits tumour necrosis factor (TNF), a central controller of inflammation thought to be upregulated in COVID-19.

 

Infliximab

Trial recommended to: REMAP-CAP

Date: 12 February 2021

Why it was recommended:

Infliximab is widely used to treat inflammatory diseases such as arthritis. Infliximab blocks one of the pathways for inflammation in the body. By reducing the body’s inflammatory response, infliximab might prevent or reduce the severity of the COVID-19 illness.

Specifically, infliximab inhibits tumour necrosis factor (TNF), a central controller of inflammation thought to be upregulated in COVID-19.

 

Prednisolone

Trial recommended to: REMAP-CAP

Date: 30 March 2021

Why it was recommended:

In patients discharged from hospital after recovering from COVID-19, there is evidence of ongoing inflammation and damage to multiple organs, including the lung.

Prednisolone is a type of steroid drug that broadly suppresses inflammation in the body. In doing so, prednisolone might prevent or reduce the severity of inflammation contributing to symptoms and signs of ‘long COVID’. Steroid drugs are widely used and well understood in the clinical context of inflammation.

Specifically, prednisolone is a synthetic glucocorticoid used extensively for its broad-spectrum anti-inflammatory and immunosuppressive effects.

 

Complement (C5) inhibitors

Trial recommended to: RECOVERY+

Date: 1 February 2021

Why it was recommended:

The complement pathway is an inbuilt system to remove infections, which is activated as part of the body’s response to COVID-19. However, this can also lead to high levels of inflammation in the lungs and blood, causing damage to organs as well as generation of blood clots. Complement inhibitors act on the part of the complement system that is critical to the inflammatory response, but leaves intact the parts important for killing viruses.

Specifically, drugs inhibiting C5 (the terminal complement pathway) have been recommended for trial.

 

Higher-dose dexamethasone

Trial recommended to: RECOVERY+ and REMAP-CAP

Date: 14 April 2021

Why it was recommended:

Dexamethasone is a type of steroid drug that has been shown to reduce the inflammation seen in severe COVID-19.

Dexamethasone has been successful in clinical trials of COVID-19, at a medium dose of 6 mg daily. There is evidence that using these drugs at higher doses may give additional benefits in certain patients. The selected dose represents a balance between the anti-inflammatory benefits and the risks of higher doses, which are well understood from clinical practice.

Specifically, dexamethasone is a synthetic glucocorticoid used extensively for its broad-spectrum anti-inflammatory and immunosuppressive effects.

Last updated: 12 October 2021

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