Scientists race to find a cure or vaccine for the coronavirus. Here are the top drugs in development

Health officials and scientists across the world are racing to develop vaccines and discover effective treatments against the coronavirus, which has infected more than 4.2 million people worldwide in as little as four months, according to data compiled by Johns Hopkins University.

There are no proven, knockout treatments and U.S. health officials say a vaccine could take at least a year to 18 months.

On May 1, the Food and Drug Administration granted emergency use authorization for Gilead Sciences‘ antiviral drug remdesivir. This after a government-run clinical trial found Covid-19 patients who took remdesivir usually recovered after 11 days. That is four days faster than those who didn’t take the drug. The EUA means doctors in the U.S. will be allowed to use remdesivir on patients hospitalized with Covid-19 even though it has not been formally approved by the agency.

Even if the drug wins final approval, infectious disease specialists and scientists say researchers will need an arsenal of medications to fight this respiratory virus, which can also attack the cardiovascular, nervous, digestive and other major systems of the body.

Below is a list of the leading vaccines and drugs in development to battle Covid-19.

Moderna

• Vaccine: mRNA
• Development: Phase 1 trial near complete, phase 2 trial set to start

The National Institutes of Health, an agency within the Department of Health and Human Services, has been fast-tracking work with biotech company Moderna to develop a vaccine to prevent Covid-19. The company began the first phase 1 human trial on 45 volunteers testing a vaccine to prevent the disease in March and has been approved to soon start its phase 2, which would expand the testing to 600 people, by late May or June. If all goes well, its vaccine could be in production as early as July.

Moderna’s potential vaccine contains genetic material called messenger RNA, or mRNA, that was produced in a lab. The mRNA is a genetic code that tells cells how to make a protein and was found in the outer coat of the new coronavirus, according to researchers at the Kaiser Permanente Washington Health Research Institute. The mRNA instructs the body’s own cellular mechanisms for making proteins to create those that mimic the virus proteins, thereby producing an immune response.

Johnson & Johnson

• Vaccine: Modified adenovirus
• Development: Preclinical

Johnson & Johnson began Covid-19 vaccine development in January. J&J’s lead vaccine candidate will enter a phase 1 human clinical study by September, the company announced in March, and clinical data on the trial is expected before the end of the year. If the vaccine works well, the company said it could produce 600 million to 900 million doses by April 2021.

The company said it is using the same technologies it used to make its experimental Ebola vaccine, which was provided to people in the Democratic Republic of Congo in late 2019. It involves combing genetic material from the coronavirus with a modified adenovirus that is known to cause common colds in humans.

Inovio Pharmaceutical

• Vaccine: INO-4800
• Development: Phase 1 trials

Inovio began its early stage clinical trials for a potential vaccine on April 6, making it the second potential Covid-19 vaccine to undergo human testing after Moderna. It says it will enroll up to 40 healthy adult volunteers in Pennsylvania and Missouri and expects initial immune responses and safety data by late summer. Inovio made its potential vaccine by adding genetic material of the virus inside synthetic DNA, which researchers hope will cause the immune system to make antibodies against it.

Oxford University

• Vaccine: ChAdOx1 nCoV-19
• Development: Phase 1 trials

A coronavirus vaccine developed by researchers at Oxford University began phase 1 human trials on April 23. British Health Minister Matt Hancock said that he would provide £20 million, ($24.5 million), to help fund the Oxford project. The team said it aims to produce 1 million doses by September.  

Oxford researchers are calling their experimental vaccine ChAdOx1 nCoV-19, and it’s a kind of recombinant viral vector vaccine. Like J&J’s team, the researchers will place genetic material from the coronavirus into another virus that’s been modified. They will then inject the virus into a human, hoping to produce an immune response.

Pfizer

• Vaccine: BNT162
• Development: Clinical trials

Pharmaceutical giant Pfizer, which is working alongside German drugmaker BioNTech, began testing an experimental vaccine to combat the coronavirus in the U.S. on May 5. The U.S.-based drugmaker hopes to produce “millions” of vaccines by the end of this year and expects to increase to “hundreds of millions” of doses next year. The experimental vaccine uses mRNA technology, similar to Moderna. The mRNA is a genetic code that tells cells what to build — in this case, an antigen that may induce an immune response for the virus.

Sanofi and GSK

• Vaccine: Unnamed
• Development: Preclinical

Sanofi and GSK announced April 14 that they had entered an agreement to jointly create a Covid-19 vaccine by the end of next year. The companies plan to start clinical trials in the second half of 2020 and, if successful, produce up to 600 million doses next year. To make it, Sanofi said it will repurpose its SARS vaccine candidate that never made it to market while GSK will provide pandemic adjuvant technology, which is meant to enhance the immune response in vaccines.

Novavax

• Vaccine: NVX-CoV2373
• Development: Preclinical 

Novavax announced on April 8 it found a coronavirus vaccine candidate and would start human trials in May with preliminary results expected in July. The potential vaccine, which is being called NVX-CoV2373, is using adjuvant technology and will attempt to neutralize the so-called spike protein, found on the surface of the coronavirus, which is used to enter the host cell.

Gilead Sciences

• Drug: Remdesivir
• Development: Late-stage trials

The FDA granted emergency use authorization for Gilead’s remdesivir drug to treat Covid-19 on May 1. The National Institute of Allergy and Infectious Diseases released results from its study showing patients who took remdesivir usually recovered faster than those who didn’t take the drug. Even though remdesivir was granted for emergency use, there are still several ongoing clinical trials testing whether it’s effective in stopping the coronavirus from replicating.

Remdesivir has shown some promise in treating SARS and MERS, which are also caused by coronaviruses. Some health authorities in the U.S., China and other parts of the world have been using remdesivir, which was tested as a possible treatment for the Ebola outbreak, in hopes that the drug can improve the outcomes for Covid-19 patients. The company said it expects to produce more than 140,000 rounds of its 10-day treatment regimen by the end of May and anticipates it can make 1 million rounds by the end of this year.

New York state and others

• Drug: Hydroxychloroquine
• Development: Various clinical trials

Hydroxychloroquine is a decades-old malaria drug touted by President Donald Trump as a potential “game-changer.”

The drug is proven to work in treating Lupus and rheumatoid arthritis, but not Covid-19. A handful of small studies on its use in coronavirus patients published in France and China had raised hope that the drug might help fight the virus. However, hydroxychloroquine, which is available as a generic drug and is also produced under the brand name Plaquenil by French drugmaker Sanofi, can have serious side effects, including muscle weakness and heart arrhythmia.

The FDA issued a warning against taking the drug outside a hospital or formal clinical trial setting after it became aware of reports of “serious heart rhythm problems” in patients.

On March 24, researchers at NYU Langone in New York launched one of the nation’s largest hydroxychloroquine clinical studies after federal health regulators fast-tracked approvals for coronavirus research, allowing scientists across the nation to skip through months of red tape. It’s one of more than a dozen formal studies in the U.S. looking at treatments for the coronavirus, according to ClinicalTrials.gov.

But the early results aren’t so promising. An observational study published in the journal JAMA Network Open on Monday and run by the New York State Department of Health, in partnership with the University of Albany, found that it didn’t help coronavirus patients. Worse yet, when taken with azithromycin — which French researchers credited with speeding recovery times — it put patients at significantly higher risk of cardiac arrest. 

Zhejiang Hisun Pharmaceutical

• Drug: Favipiravir
• Development: Midstage trial

Favipiravir is an anti-flu drug sold by Fujifilm Holding under the name Avigan. Researchers in China are testing the drug to see if it’s effective in fighting the coronavirus. Most of favipiravir’s preclinical data is derived from its influenza and Ebola activity; however, the agent also demonstrated broad activity against other RNA viruses, according to researchers in Japan.

Regeneron and Sanofi

• Drug: Kevzara
• Development: Clinical trials

Regeneron and Sanofi started clinical trials of rheumatoid arthritis drug Kevzara in Covid-19 patients in March. The drug inhibits a pathway thought to contribute to the lung inflammation in patients with the most severe forms of Covid-19.

The companies announced last month that Kevzara showed promise for treating the sickest coronavirus patients in a clinical trial but it wasn’t beneficial for patients with less-advanced disease, prompting the companies to stop testing the medicine in that group.

Eli Lilly

• Drug: Baricitinib
• Development: Clinical trials

Eli Lilly, in partnership with National Institute of Allergy and Infectious Diseases, is seeing if its rheumatoid arthritis drug baricitinib is effective against the coronavirus. The company theorizes that baricitinib’s anti-inflammatory effects could curb the body’s reaction to the virus.

Eli Lilly, AstraZeneca and Regeneron 

• Drug: Antibody treatments
• Development: Various stages

While some drugmakers are looking for vaccines to stop the virus, Eli Lilly, AstraZeneca and Regeneron, among other companies, are working on so-called antibody treatments, which are made to act like immune cells and may provide protection after exposure to the virus. Earlier this month, Regeneron said its treatment could be available for use by the end of this summer or fall.