Quest for Wisdom #2: The clinical trials dilemma

So, we’ve had here a rather fascinating discussion on medical trials here in Central Europe. What started it was a renown vaccinologist catching COVID, only to instantly treat himself and his son with Isoprinosine, which is an inosin pranobex-based drug that has been used to treat acute respiratory viral infections since the seventies (you might know it as Imunovir).

That made the national headlines, and was followed up by other doctors coming forward, saying that they also used Isoprinosine to treat COVID patients, mostly with great results – the drug seems to lead to a sharp decrease to the severity of the infection, so the patient  gets only mild symptoms, and thus avoids the risk to life.

What’s the idea? In grossly simplified terms to make it easier to understand, the pill stimulates the immune system to produce more natural killer cells (yes, they are actually called that), which do an internal body cleanup in the sense that they travel through the body, and destroy cells they find to be infected with a foreign element (in our case, COVID).

They don’t destroy all of the infected the cells, but enough to slow down the progress of the infection to buy enough time for adaptive immunity to solve the problem.

Great, but does it really work?

Well, probably, and that’s where the discussion started. The fundamental logic is solid, there is anecdotal evidence of it working, so it would make sense to do a full-scale clinical trial to determine if inosin pranobex-based medicine actually works on COVID.

Okay, so who’s going to actually do that trial?

Well, that’s the hard question. Most clinical trials are done by pharmaceutical companies during the process of the introduction of a new drug. These trials require a lot of infrastructure, are brutally expensive, and take forever to get done. Especially the costs are the problem here, because the usual assumption is that the costs of the medical trials will be compensated by the profits from selling the new drug.

Yet inosin pranobex-based drugs have been around since the seventies. The treatment costs around $20 and over 30 pharmaceutical companies already manufacture and sell such a drug. So, the potential profit from doing a clinical trial for this drug is pretty much zero dollars. But the costs are still in millions of dollars.

Worse, many pharmaceutical companies are spending massive sums of money on development of anti-COVID drugs and vaccines. If a clinical trial proves that an old, cheap drug that everyone already produces functions as an effective cure, then all the development investment might as well be written off, because nobody needs a new, expensive drug if an old, cheap drug does the job.

For a pharmaceutical company, running a clinical trial on inosin prannobex would be the equivalent to me paying someone to steal my car. Whether he successfully steals it or not, I’m worse off than if I did nothing.

So, if pharmaceutical companies won’t do the clinical trials for old drugs, then who will?

That’s where the discussion turned sour. The state doesn’t have any of the necessary capabilities to run full-scale clinical trials. The universities here can, with extreme effort, run small-scale clinical trials, but are even slower and a small-scale clinical trial isn’t going to cut it given the prevalence of COVID.

The final nail in the coffin to that line of thought was that the Ain Shams University of Egypt is already running an inosin prannobex clinical trial (source: https://clinicaltrials.gov/ct2/show/NCT04360122).

So, in the end, we’re most likely going to wait for the Egyptians to do the hard work for us.

The discussion that’s ongoing is if the state should build the infrastructure to run its own clinical trials. It would be great to have it now that there’s a pandemic. But what would it be used for once the pandemic is over?

And that’s point where the discussion on the clinical trial dilemma has currently reached in here, so I have little more to add.

The list of all inosin prannobex drugs:

The main source article for the medical part:

https://www.prolekare.cz/tema/hpv-condylomata-ari/detail/inosine-pranobex-in-the-prevention-and-treatment-of-acute-respiratory-viral-infections-including-covid-19-answers-to-frequently-asked-questions-from-healthcare-professionals-121758 (the webpage is in Czech but the article is in English)

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