UNSTRUCTURED
Real-world drug repurposing – the immediate ‘off-label’ prescribing of drugs to address urgent clinical need – is an indispensible strategy gaining rapid traction in the current COVID-19 crisis. Although off-label prescribing (i.e. for a non-approved indication) is legal in most countries, it tends to shift the burden of liability or cost to physicians and patients, respectively. Nevertheless, in urgent public health crises it is often the only realistic source of meaningful potential solutions. To be considered for real-world repurposing, drug candidates should ideally have a track record of safety, affordability, and wide accessibility. Although thousands of such drugs are already available, the absence of a central repository of off-label uses presents a barrier to the immediate identification and selection of the safest potentially useful interventions. Using the current COVID-19 pandemic as an example, we provide a glimpse of the extensive literature that supports the rationale behind six generic drugs, in four classes, all of which are affordable, supported by decades of safety data, and pleiotropically target the underlying pathophysiology that makes COVID-19 so dangerous. Having previously fast-tracked this paper to publication in summary form, we now expand on why cimetidine or famotidine, dipyridamole, fenofibrate or bezafibrate, and sildenafil, are worth considering for patients with COVID-19. These examples also reveal the unlimited opportunity to future-proof our health by proactively mining, synthesizing, and cataloging the off-label treatment opportunities of thousands of safe, well established, and affordable generic drugs.