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

Abstract

Purpose

Global fears regarding future epidemics of new and re-emerging infections will prompt clinicians to try out unconventional treatments based on limited evidence, including the repurposing of existing drugs. The dilemma involves balancing clinical intuition with the need to rely on low-quality information because of the scarcity of definitive evidence. An example was ivermectin; with its potential antiviral properties, it was promoted for its efficacy in treating coronavirus disease 2019 despite conflicting outcomes in clinical trials and varying expert opinions. This article describes the development of a decision-making framework to resolve such dilemmas.

Methods

The case study from Sri Lanka illustrates multiple challenges faced by clinicians. As the horrific details of deaths in countries such as Italy spread on social media, there was panic and an unprecedented demand for 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 eventually led to the authorities to recommend limited approval for use under physician supervision.

Findings

The situation lent itself to a framework with 4 elements: prerequisites, applying an appropriate decision-making tool (eg, multiple criteria decision-making methods), ethical considerations, and sensitive communication.

Implications

We 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 new or re-emerging infections.