JMIR Publications

ABSTRACT

Real-world drug repurposing – the immediate ‘off-label’ prescribing of drugs to address urgent clinical need – is a widely overlooked opportunity. Off-label prescribing (i.e. for a non-approved indication) is legal in most countries, and tends to shift the burden of liability or cost to physicians and patients, respectively. Nevertheless, health crises may mean that real-world repurposing is the only realistic source of solutions. Optimal real-world repurposing requires a track record of safety, affordability, and access for drug candidates. Although thousands of such drugs are already available, there is no central repository of off-label uses to facilitate immediate identification and selection of potentially useful interventions during public health crises. 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 target the underlying pathophysiology that makes the virus deadly. This paper briefly summarizes why cimetidine or famotidine, dipyridamole, fenofibrate or bezafibrate, and sildenafil citrate, 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.