Coronavirus disease 19 (COVID-19) is a severe acute respiratory syndrome caused by SARS-CoV-2 (2019-nCoV). While no drugs have yet been approved to treat this disease, small molecules effective against other viral infections are under clinical evaluation for therapeutic abatement of SARS-CoV-2 infections. Ongoing clinical trials include Kaletra (a combination of two protease inhibitors approved for HIV treatment), remdesivir (an investigational drug targeting RNA-dependent RNA polymerase [RdRP] of SARS-CoV-2), and hydroxychloroquine (an approved anti-malarial and immuno-modulatory drug). Since SARS-CoV-2 replication depends on three virally encoded proteins (RdRP, papain-like proteinase, and helicase), we screened 54 FDAapproved antiviral drugs and ~3300 investigational drugs for binding to these proteins using targeted and unbiased docking simulations and computational modeling. Elbasvir, a drug approved for treating hepatitis C, is predicted to bind stably and preferentially to all three proteins. At the therapeutic dosage, elbasvir has low toxicity (liver enzymes transiently elevated in 1% of subjects) and well-characterized drug-drug interactions.We predict that treatment with elbasvir, alone or in combination with other drugs such as grazoprevir, could efficiently block SARS-CoV-2 replication. The concerted action of elbasvir on at least three targets essential for viral replication renders viral mutation to drug resistance extremely unlikely.
Author SummaryWe performed in silico screens of FDA-approved and investigational drugs, to seek rapidly deployable agents that could be combined to disrupt multiple viral targets. One drug stood out with exceptionally stable binding to the three initial protein targets essential for SARS-CoV-2 replication: elbasvir, currently approved as one component of Zepatier TM (Merck) for treatment of chronic hepatitis C infections. Elbasvir was in the top decile of drugs for stable binding to each of 6 SARS-CoV-2 proteins, and thus is predicted to confer a multi-pronged defence against COVID-19, either alone or in combination with other anti-viral drugs.