Doctors are asking states to use their lethal-injection drugs to treat patients with COVID-19, instead
States that execute prisoners by lethal injection have a stockpile of drugs that, amid the pandemic, are now in short supply. "Your stockpile could save the lives of hundreds of people," a group of doctors and public health experts wrote in an April 9 letter to state prison officials. States like Texas have been unable to carry out executions due to the disruption in the court system.
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US doctors and public health experts are asking states to hand over their death-penalty drugs — to save lives. In an April 9 letter to directors of state prisons, obtained by The Marshall Project's Keri Blakinger, the medical experts said: "the medicines your states are currently holding for use in lethal injection executions are in short supply and desperately needed to treat patients suffering from COVID-19."
#BREAKING Today, a group of physicians & med experts wrote an open letter to death penalty states asking them to give up their execution drugs: Doctors need them to treat COVID patients on ventilators as sedatives & paralytics - sometimes used in executions - are running short. pic.twitter.com/xHXblVPjsj — Keri Blakinger (@keribla) April 9, 2020
States that carry out lethal injections use a cocktail of drugs, including sedatives and paralytics, that can also be used to alleviate respiratory problems and enable the use of a ventilator. Earlier this month, The New York Times reported that supplies of such medications were critically short. "We're running out of all the drugs," one doctor told the paper. Over 2,600 people are currently awaiting execution, according to the Death Penalty Information Center. Thirty states, plus the federal government, "use lethal injection as their primary method," while others use it as a backup. Since the pandemic, states have not even been using these drugs for that. On April 1, a Texas court issued a stay of execution, its third since the outbreak, citing the disruption to the court system. In their letter, the experts, such as Harvard Medical School's Prashant Yadav and David Waisel, argued that the drugs death-penalty states typically use to take lives could, instead, be used to help front-line doctors extend them. "Your stockpile could save the lives of hundreds of people," they wrote. "At this crucial moment for our country, we must prioritize the needs and lives of patients above ending the lives of prisoners." Have a news tip? Email this reporter: email@example.comJoin the conversation about this story » NOW WATCH: Extremists turned a frog meme into a hate symbol, but Hong Kong protesters revived it as an emblem of hope
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New data in hand, the W.H.O. recommended that doctors give the drugs to critically ill patients...New data in hand, the W.H.O. recommended that doctors give the drugs to critically ill patients worldwide.
Wesley Ira Purkey spoke out against capital punishment before receiving lethal injection in IndianaThe United States...Wesley Ira Purkey spoke out against capital punishment before receiving lethal injection in IndianaThe United States on Thursday carried out its second federal execution this week, killing by lethal injection a Kansas man whose lawyers contended he had dementia and was unfit to be executed.Wesley Purkey was put to death at the Federal Correctional Complex in Terre Haute, Indiana. Continue reading...
Drugmakers are racing to repurpose existing medicines to fight the novel coronavirus. Here's what you need to know about the 17 leading medications being put to the test.
Researchers are trying a wide range of existing drugs against the novel coronavirus, hoping to find...Researchers are trying a wide range of existing drugs against the novel coronavirus, hoping to find a treatment that fights the virus or alleviates patients' symptoms. These repurposed drugs are the only near-term hope for a coronavirus treatment as cases surge in the US. Dozens of trials are now testing them in patients with COVID-19, the disease caused by the virus. On June 16, researchers revealed that dexamethasone, a cheap, widely available steroid, managed to reduce deaths in patients with severe COVID-19, becoming the first treatment to show that benefit in the disease. Drugmakers are also crafting new therapeutics and vaccines tailored for this coronavirus. While these efforts hold great promise in halting the virus, they all require at least several months of development and testing. Business Insider reviewed the research landscape and identified 17 leading treatments that are now being tested against COVID-19. Visit Business Insider's homepage for more stories. Repurposed drugs are the most promising options for finding a treatment quickly for COVID-19, the disease caused by the novel coronavirus. Dozens of clinical trials are testing drugs originally designed for other ailments, such as Ebola, HIV, malaria, and arthritis. These potential treatments have already been tested in humans for other diseases, and some are already approved to treat other conditions. That means we already know how safe they are for people to take, and what side effects to expect. Researchers can skip some early steps and move quickly into human trials testing how well the drugs work in COVID-19. As cases surge in the US, some of that research into potential treatments is getting put to work with the hopes of helping more survive COVID-19. For instance, on June 16, researchers revealed that dexamethasone, a cheap, widely available steroid, managed to reduce deaths in patients with severe COVID-19. While repurposed drugs can be tested now, they aren't expected to be anything close to a panacea for the virus. The gold standard for halting infectious diseases remains vaccines, which can protect healthy people from getting infected in the first place. Read more: There are more than 25 coronavirus vaccines set to be tested in people this year. Here are the 10 leading vaccine candidates, and what to watch for in the rest of 2020. Vaccine research typically takes years. Even under the urgency of this pandemic, US health officials have said it will take at least a year to know if any vaccine is safe and effective. Simultaneously, biotech and pharma companies are scrambling to craft new therapeutics. These will be tailored specifically to fighting this novel coronavirus. Even under the most aggressive timetables for clinical testing, those won't be widely available to patients until at least the fall. That leaves repurposed drugs as the near-term hope. Here are the top candidates and how they are being tested against COVID-19. This article was initially published in April 2020 and has been updated. Dexamethasone On June 16, dexamethasone, a common, cheap, steroid became the first drug to reduce deaths in severely ill COVID-19 patients in a clinical trial, according to a statement released by the trial's lead investigators. Giving the steroid in critically ill COVID-19 patients on ventilators reduced deaths by one-third, and it reduced deaths in patients on oxygen by 20%. COVID-19 patients who didn't need help with breathing didn't benefit from the drug. Dexamethasone is one of a number of corticosteroids, which acts on the immune system by providing relief to inflammation in the body. In critically ill COVID-19 patients, doctors have thought that it might be the body's response to the virus — rather than the virus itself — that's wreaking havoc on the body. The World Health Organization has previously recommended against using corticosteroids in COVID-19, particularly in treating viral pneumonia, based on a review of how well the drugs worked in past coronavirus outbreaks. One of the concerns the organization had was over whether the steroids would help keep the virus replicating, known as viral shedding. Major studies to watch: Trials are ongoing in Spain and France to see how well the drug works in critically ill COVID-19 patients with acute respiratory distress syndrome and pneumonia, respectively. Remdesivir Remdesivir is an antiviral drug developed by Gilead Sciences in 2009. It was previously tested in more than 100 Ebola patients during that outbreak. Through clinical trials and expanded access programs, thousands of COVID-19 patients have already been treated with remdesivir. The National Institutes of Health released data showing the drug helps coronavirus patients recover more quickly from the virus. Based on that data, the FDA on May 1 issued an emergency authorization for the drug's use. While it's not an approval, it could allow for more hospitalized patients to receive the drug. On June 1, Gilead said that remdesivir helped hospitalized patients with more moderate forms of COVID-19 recover more quickly when receiving the treatment for 5 days. The results were mixed, however, in moderately ill patients who received the treatment for 10 days. In that case, results weren't statistically significant, the company said. For now, the drug is authorized to be given to severely ill hospitalized patients via an intravenous infusion over the course of a five- or 10-day period. But starting in August, Gilead is exploring how remdesivir might work in an inhaled version, which could make it more widely available for use in treating COVID-19 in patients who aren't hospitalized. Read more: The 3-decade rise of Gilead, from California startup to the biotech with the best chance yet at an effective coronavirus treatment Major studies to watch: Full results from Gilead's study enrolling 1,600 moderate COVID-19 patients randomized to either 5-day IV infusion of remdesivir, 10-day infusion of remdesivir, or standard of care (link) A WHO trial involving over 90 countries, testing remdesivir, Kaletra, and interferon-beta-1a in COVID-19 patients (link) Hydroxychloroquine Hydroxychloroquine is a widely used medication by people with lupus or arthritis. It was first approved in the 1950s. Early in the pandemic, the drug caught the eyes of doctors, experts, and the Trump administration as a potential coronavirus treatment. Some early, promising results regarding the drug were published in late March. Since then, the drug has largely been written off as a potential treatment for COVID-19. In June, the University of Minnesota released results from its randomized controlled trial testing whether hydroxychloroquine can prevent coronavirus. The first high-quality look at the medication's use to prevent COVID-19, the study found that the drug did not help prevent infections. Two observational studies, published in the New England Journal of Medicine and the Journal of the American Medical Association, found that among thousands of hospitalized coronavirus patients, those who received the antimalarial medication hydroxychloroquine didn't fare better or worse than patients who didn't receive the drug. In the wake of the results, a number of clinical trials have been called off. A WHO trial involving over 90 countries testing remdesivir, hydroxychloroquine, Kaletra, and interferon-beta-1a in COVID-19 patients dropped the hydroxychloroquine arm of the trial in June. The NIH in June also halted a trial after determining the drug is "very unlikely to be beneficial" in hospitalized patients. And on June 15, the FDA revoked an emergency use authorization issued early in the pandemic for the drug. The drug has not been approved by the FDA to treat COVID-19. Read more: The first high-quality study of malaria pill hydroxychloroquine just found it doesn't help prevent coronavirus infections Major studies to watch: The Bill and Melinda Gates Foundation is working with the University of Washington and other partners to test 2,000 asymptomatic people who are in close contact with a COVID-19 patient. The trial randomly assigns either hydroxychloroquine or vitamin C pills as a placebo comparison (link) The University of Oxford is recruiting 40,000 participants to test the malaria drug as preventive treatment for frontline healthcare workers. Volunteers will receive either hydroxychlorouqine in Europe or chloroquine in Asia and be compared against a placebo arm (link) Azithromycin Azithromycin is a widely prescribed generic antibiotic, sometimes referred to as Z-Pak. While it's used to fight bacteria, not viruses, there is some research suggesting the drug has antiviral properties. Pharma company Pfizer in April published a review of these antiviral characteristics seen in laboratory research and clinical tests with the intent of facilitating further research of how azithromycin works in COVID-19. Several trials are testing azithromycin in combination with hydroxychloroquine. An observational study published in the Journal of the American Medical Association in May found that those who received hydroxychloroquine, the antibiotic azithromycin, or both hydroxychloroquine and azithromycin didn't have meaningfully lower rate of in-hospital deaths compared to patients who didn't receive the drugs. One potential concern is serious heart side effects. Azithromycin drugs can cause abnormal changes in the rhythm of the heart. These can be fatal, particularly for susceptible patients who already have heart problems. Many studies are using EKG tests to closely monitor patients receiving this treatment combinations of the antibiotic and hydroxychloroquine. Major studies to watch: Intermountain Health Care and the University of Utah will treat 300 COVID-19 patients with either azithromycin or hydroxychloroquine. (link) They are also testing 1,550 COVID-19 patients in an outpatient setting with either hydroxychloroquine or azithromycin (link) Rutgers University is testing 160 COVID-19 patients with either hydroxychloroquine or hydroxychloroquine and azithromycin (link) Duke University will test 500 hospitalized COVID-19 patients randomly with either standard of care or hydroxychloroquine. Those selected for hydroxychloroquine will also be randomized to either receive azithromycin in addition or just hydroxychloroquine (link) Kevzara Kevzara was approved in the US in 2017 to treat rheumatoid arthritis. The biologic injection is an anti-inflammatory medication. Regeneron and Sanofi co-promote the drug. It may help the most severe COVID-19 patients who are suffering from an overactive immune response. This condition, known as a cytokine storm, may be the reason some patients crash. Kevzara inhibits a key cytokine called IL-6. In April, however, researchers narrowed a clinical trial of the drug Kevzara after an early review of how the treatment was working. The early look at the data led researchers to focus exclusively on critically ill patients, instead of more broadly testing it on severely and critically ill patients. Critical patients are on ventilators, high-flow oxygen therapy, or they're in the intensive care unit. The study is now looking at just higher doses of the medication as well. Read more: A potential coronavirus treatment just suffered an early setback, and researchers are now focusing their efforts on the sickest COVID-19 patients Major studies to watch: Regeneron is running a US trial of 400 hospitalized COVID-19 patients with severe cases. It randomizes patients to a low dose, high dose, or placebo arm (link) Sanofi is running a trial outside the US of 300 severe COVID-19 patients, also testing a low dose and high dose against a placebo comparison (link) Actemra Like Kevzara, Actemra is an IL-6 inhibitor. First approved in 2010 to treat arthritis, Actemra also gained approval in 2017 to treat cytokine release syndrome, a severe immune response stemming from certain cancer treatments. Now, some severe COVID-19 patients are suffering a similar overreaction in their immune responses. The Swiss pharma Roche has already enrolled 450 patients in a late-stage COVID trial. The US Biomedical Advanced Research and Development Authority (BARDA) provided $25 million to accelerate that research. On May 27, the company announced two additional trials, one in combination with Gilead's remdesivir. Read more: The first patients just enrolled in a trial testing the arthritis drug Actemra against the coronavirus. Results are expected in early summer. Major studies to watch: Roche enrolled 450 severe COVID-19 patients with pneumonia, randomizing them between an IV infusion of Actemra or placebo. As of June, the trial was no longer recruiting, and the company said it'd share results "as soon as possible this summer" (link) In May, Roche began a trial looking to evaluate the use of Actemra in combination with Gilead's remdesivir. The study expected to start enrolling 450 people worldwide into the trial starting in June (link) In May, Roche also began a trial of 375 at sites caring for minority populations that don't often have access to clinical trials, the company said. (link) Convalescent plasma Convalescent plasma is a century-old treatment technique that has generated encouraging — yet early — results as a COVID-19 treatment. The treatment requires recovered COVID-19 patients to donate blood that is rich in the antibodies that fight the virus. These are then infused into hospitalized patients with severe disease. Japan's largest pharmaceutical company is leading a worldwide collaboration to use the blood of recovered COVID-19 patients to treat others. While the company first planned to develop its own treatment using this approach, it started a partnership in April to work with other companies and expedite the process of collecting plasma donations. These plasma specialists will develop one unbranded medicine for patients with severe COVID-19. In May, the Mayo Clinic reported safety data on 5,000 hospitalized patients that received convalescent plasma in the US. Early indications suggested the treatment is safe. If further studies validate this approach, a critical challenge will be scaling up this treatment to address a pandemic. That requires having widespread and reliable antibody testing as well as the medical workers to collect blood and get plasma to patients in need. Read more: A new report raises hope that the blood of recovered patients can help treat severe coronavirus cases Major studies to watch: Netherlands researchers are recruiting 426 severe COVID-19 patients to randomly receive either convalescent plasma or just standard of care (link) The Food and Drug Administration has set up a national expanded access program. As of May 11, more than 14,000 patients had enrolled and 8,900 patients had been infused with the treatment (link) Jakafi Jakafi is a JAK inhibitor approved to treat graft vs host disease, which is caused by an immune reaction following stem cell or bone marrow transplants. Like IL-6 inhibitors, Jakafi could calm down the immune system's overreaction to the coronavirus. Swiss pharma Novartis and Incyte said in April that they'd begun a trial evaluating how well it works in COVID-19 patients who have the so-called cytokine storm reaction. That study will see if the drug can reduce the number of patients requiring intensive care and ventilators. Major studies to watch: In April, Novartis and Incyte said that it had begun recruiting for a 402-person phase 3 trial, in patients with COVID-19 associated cytokine storm, assigning patients to either Jakafi or placebo (link) Incyte also started a second 500-person phase 3 trial to see how Jakafi might work in COVID-19 patients with acute respiratory distress syndrome who are on mechanical ventilation (link) Avigan Fujifilm Toyama Chemical's Avigan is an influenza treatment and a broad-spectrum antiviral drug. It's not approved in the US, but is used in Japan and China. Avigan outperformed another antiviral drug called arbidol in a trial conducted in China, according to a recent report of those findings. The flu drug helped COVID-19 patients recover seven days faster than the patients on arbidol and reduced the frequency of symptoms like coughing and fever. In May, Russia approved the treatment for use in fighting the novel coronavirus, with officials saying preliminary tests showed that hospitalized patients who received the drug recovered more quickly than those who didn't.The full results of that study have not been released as of yet. A couple studies are ongoing in China. Major studies to watch: Three Massachusetts hospitals will run the first US trials of Avigan, enrolling about 50 COVID-19 patients (link) Kaletra Kaletra is an HIV therapy combining two antiviral medicines: lopinavir and ritonavir. It was approved by the FDA in 2000. One randomized study from China comparing the drug against placebo found no benefit in COVID-19. Read more: An HIV drug failed to help patients with severe cases of COVID-19, according to disappointing results from one of the first coronavirus drug trials Major studies to watch: A WHO trial involving over 90 countries will test remdesivir, hydroxychloroquine, Kaletra, and interferon-beta-1a in COVID-19 patients (link) Galidesivir Galidesivir is an experimental antiviral treatment designed to fight RNA viruses. Since 2013, the drug has received funding from the NIH and BARDA as a treatment for yellow fever and Ebola. Last year, galidesivir's developer, a small drugmaker called BioCryst Pharmaceuticals, completed a safety study, testing the antiviral in 24 volunteers and concluding it was generally safe. Now, the NIH is funding a COVID-19 trial in Brazil, testing galidesivir against placebo. On April 9, BioCryst announced it has started enrolling patients. Major studies to watch: NIH trial in Brazil testing 66 COVID-19 patients with either galidesivir or placebo (link) Remestemcel-L Others are looking at whether a stem cell therapy help some COVID-19 patients recover. Mesoblast is an Austalian regenerative medicine company that is now applying an experimental stem cell treatment called remestemcel-L to the pandemic. The company is working with NIH researchers to run a large randomized trial for patients with respiratory distress due to COVID-19. Like other medicines being tested, the treatment is aiming to quiet an overactive immune response in certain patients. This intravenous stem cell infusion has been given to more than 1,100 patients in other settings, although it is not yet FDA-approved. (The FDA is expected to make an approval decision by October on remestemcel-L as a treatment for graft versus host disease in children.) Major studies to watch: A placebo-controlled randomized study in 300 patients in acute respiratory distress caused by COVID-19 (link) Tradipitant Tradipitant has not been approved for any medical use, but is being tested in atopic dermatitis, gastroparesis, and motion sickness. The drug inhibits neurokinin-1, which can help suppress nausea and vomiting. Its developer, Vanda Pharmaceuticals, hopes it can treat lung injury associated with coronavirus infections. Vanda stated the NK-1 receptor is involved in the inflammatory process that leads to lung injury. Major studies to watch: Vanda is running a study, starting in New York, for 300 COVID-19 patients who are hospitalized and suffering from pneumonia. They will randomly receive either tradipitant or placebo. As of April, the trial is only enrolling by invitation (link) Selinexor Selinexor was approved in 2019 to treat a type of blood cancer. Now, it will be tested to help COVID-19 patients in the hospital. Its developer, Karyopharm Therapeutics, has done laboratory work suggesting it may block viral proteins that play a role in the virus' spread. It also could have an anti-inflammatory benefit for patients, according to the company. Major studies to watch: Karyopharm will test a low dose of selinexor against placebo in 230 hospitalized patients across six countries, including the US (link) Kineret Kineret is an IL-1 inhibitor used to treat arthritis. Like IL-6, IL-1 is "a big player in the immune response," drug discovery veteran Derek Lowe wrote in April. Italian health officials asked the drug's manufacturer Sobi to run a trial of Kineret as well as an experimental antibody treatment called emapalumab. Major studies to watch: Sobi is running a study in Italy that assigns 54 COVID-19 patients to Kineret, an experimental antibody treatment called emapalumab, or standard of care (link) Losartan Losartan is a widely used, low-cost generic heart medication. The American College of Cardiology has noted that the death rate tends to be higher from COVID-19 for people also dealing with hypertension or cardiovascular disease. Major studies to watch: For infected people who aren't yet hospitalized, University of Minnesota researchers are randomizing 580 participants to receive either losartan or placebo. The goal is reducing the number who wind up needing to go to the hospital (link) The same Minnesota researchers are also testing losartan against placebo in 200 hospitalized COVID-19 patients (link) Researchers at New York hospitals have been quietly testing whether a common heartburn medication might help critically ill patients with COVID-19, the disease caused by the novel coronavirus. The researchers are affiliated with the Feinstein Institutes for Medical Research, the research arm of New York-based health system Northwell Health. They're currently running a clinical trial to test whether high doses of famotidine help critically ill coronavirus patients survive. They're testing a dose that's nine times the amount of famotidine, or Pepcid, that someone would usually take to treat their heartburn. It's delivered intravenously over a period of seven to 10 days. Patients in the study also get hydroxychloroquine. Major studies to watch: Northwell Health is conducting a 1,170-person trial, evaluating whether the medication helps patients survive COVID-19, evaluating how many have survived after 30 days compared to those who didn't receive famotidine. (link)