Repurposing Drugs to Treat Novel Infections: A Proposal for a Decision-Making Framework for Clinicians

Abstract

PurposeFuture epidemics of novel and re-emerging infections global fear will prompt clinicians to try out unconventional treatments based on limited evidence, including repurposing of existing drugs. The dilemma involved balancing clinical intuition with the need to rely on low-quality information due to the scarcity of definitive evidence. An example was ivermectin with its potential antiviral properties and promoted for its efficacy in treating COVID-19 despite conflicting outcomes in clinical trials and varying expert opinions. The paper describes the development of a decision-making framework to resolve such dilemmas. MethodsThe case study from Sri Lanka illustrates multiple challenges faced by clinicians. As the horrific details of deaths in countries such as Italy spread in the social media, there was panic and an unprecedented demand on clinicians and health services to provide effective treatment. This led to the popularity of drugs such as ivermectin and several herbal cures. However, there was no consensus among experts on the efficacy of ivermectin which eventual led to the authorities recommending limited approval for use under physician supervision. FindingsThe situation lent itself to a framework with four elements: Prerequisites; Apply an appropriate decision-making tool (eg. Multiple Criteria Decision-Making methods); Ethical considerations; Sensitive communication. ImplicationsWe propose this framework for clinicians when they face similar situations with demands to repurpose medicines with inconclusive evidence of efficacy, to combat devastating infections from novel or re-emerging infections.