Pharmacogenomics to Drive COVID-19 Therapy for Best Outcome in a Low Resource Setting

Abstract

Corona virus disease 2019 (COVID-19) has taken the world by storm with global infectivity and mortality of 3.5%. Since there is no specific treatment for COVID-19, several drugs have been repurposed to combat infection, these include drugs like anti-malarial – chloroquine, hydroxychloroquine, anti- diarrheal– loperamide and antipsychotic-promazine, which have been considered to be effective inhibitors as of viral binding to ACE2 receptor. The administration of these drugs is currently random and is the key factors responsible for varied treatment response, hence genes involved in drug metabolism should be analysed before planning therapy. Genes involved in metabolism of the listed drugs are ABCB1, CYP1A2, CYP2C8, CYP2C19, CYP3A4 and CYP2D6. Unpublished pharmacogenomic data from our internal cohort (75 cases) was analyzed to predict likely-responders and non-responders to propose drugs for COVID-19 drug therapy in our population. Preliminary data from random individuals without bias indicates that both anti-malarials at standard dose will benefit 98% of our cases (in absence of co-morbidities), while 11-85% of individuals would require dose reduction/alternatives for loperamide and promazine. Anti-malarials like chloroquine, hydroxychroloquine can be prescribed for prophylaxis and as first line of therapy in absence of comorbidities. Simple genotype testing of ABCB1, CYP1A2, CYP2C19 and CYP2D6 is an indispensable tool to predict treatment outcomes of loperamide and promazine for COVID-19 patients.