Over 800 reads

Five years on from the onset of the COVID-19 pandemic, we are currently seeing reflection in the scientific literature detailing how we addressed the global pandemic and managed to continue conducting research [1,2]. Those were exciting times. At the start of the crisis, the global scientific community was thrust into an unprecedented race against time, pooling resources and expertise to understand a novel and devastating virus. We remember the challenges COVID brought to the conduct the necessary research to identify the SARS-CoV-2 pathogen, develop diagnostic tools, and exploring repurposed therapeutics to mitigate the disease’s impact [3].

At the start of the outbreak, I was frequently approached by individuals claiming to “have a cure for COVID,” and wanting to know how they could exploit it. The approaches were somewhat reminiscent of Jasper Carrot’s ‘Nutter on the bus’ (please forgive its 1970s humour) [4]. One approach was for the use of azoximer bromide (AZB), an immunomodulatory agent whose discovery was rooted in serendipity, mystery and change that characterised scientific endeavour in the old USSR around the days of Glasnost [5]. Unlike other approaches, this one appeared to have something. The candidate demonstrably enhanced immune responses, potentially mitigating the severity of infections, and had substantial history of use in influenza vaccines.

As the world went into lockdown, we adopted a quick-and-dirty (in that we used an open-label methodology) pilot study to explore AZBs potential. The study was conducted on the front lines of the pandemic. The investigational team battled the many challenges, not forgetting risk to their own health and the study was eventually published in the journal, Drugs in Context in 2021 [6]. Its findings have since appeared to have captured notable attention, surpassing 800 reads (according to ResearchGate).

Capturing over this number of reads from across the scientific and medical community signals a strong level of engagement, particularly considering the overwhelming number of COVID-19-related publications that have appeared in the literature over the last few years [7, 8]. In some small way it suggests the study addresses a critical gap or curiosity within the medical research community, particularly in exploring novel therapeutic interventions. We can only presume that readers include clinicians seeking actionable insights, researchers exploring alternative and adjunct treatments, and policymakers evaluating therapeutic strategies for pandemics. The focus on COVID-19 and the evaluation of AZB aligns with ongoing global efforts to understand and combat the disease.

The study investigated what was at that time the underexplored role of immunomodulators in treating COVID-19, specifically in hospitalized patients. The encouraging findings stimulated the Sponsor to further their efforts to better understand AZBs potential [9]. It is to be hoped that the work provides some understanding of how agents like AZB might be integrated into treatment protocols, particularly for severe or refractory cases. Given the challenges posed by emerging SARS-CoV-2 variants and potential resistance to existing antivirals, research into immunomodulators offers pathways to diversify therapeutic options. The number of readers interacting with the publication suggest that its message resonates with the scientific pursuit of innovative interventions to complement existing COVID-19 therapies and different approaches to bolster patient outcomes. There appears to be increasing awareness around the potential role of immunological modulators in reducing hospital stays, improving recovery trajectories, or preventing complications. In the dynamic field of COVID-19 management, where treatments are rapidly evaluated and adopted, we hope the level of readership amplifies the study’s role in fostering evidence-based decisions.

To be honest, I was pleasantly surprised that our work wasn’t lost amongst the thousands of other COVID publications – becoming part of the zombie literature that never gets cited [10]. We can only hope that our publication has come lasting legacy that inspires future researchers – even if that legacy is nothing more than to underline the value of continuing your studies in the face of adversity. Our findings have already encouraged further investigations into broader applications of AZB and similar agents in viral infections [11, 12]. Comparative trials, mechanistic studies, and long-term evaluations may stem from the insights shared. In some small way the study also paves the way for exploring how immunomodulators function in tandem with antiviral agents, vaccines, and supportive care in managing pandemics.

If nothing else, the milestone highlights the ongoing interest in novel therapeutic approaches to COVID-19, reinforces the relevance of immunomodulatory research, and underscores the study’s potential to inform clinical practice and inspire future investigations. It is not just a measure of the article’s ‘popularity’ but a reflection of the study’s contribution in addressing one of the most pressing health challenges of our time. During this period of reflection, it is good to know that we contributed, however modestly, during the time of pandemic and global crisis.

?

?

References

1. ?Cohen J. COVID 5 years later: Learning from a pandemic many are forgetting. https://www.science.org/content/article/covid-5-years-later-learning-pandemic-many-are-forgetting 2 JAN 2025
2. Sarchet P. Five years on, have we learned the lessons of covid-19? New Scientist https://www.newscientist.com/article/mg26435242-400-five-years-on-have-we-learned-the-lessons-of-covid-19/? 1 Jan 2025
3. ?Harrison F, et al. Impact of the COVID-19 Pandemic on Clinical Trial Conduct: Lessons for the Future, 14 February 2022, PREPRINT (Version 1) available at Research Square [https://doi.org/10.21203/rs.3.rs-1118410/v1]
4. ?Jasper Carrott - Nutter on the bus. https://www.youtube.com/watch?v=oYYo49R_ZS0
5. ?Grivtsova LY et al. Azoximer Bromide: Mystery, Serendipity, and Promise. Front Oncol. 2021 Sep 10;11:699546. doi: 10.3389/fonc.2021.699546.
6. ?Efimov SV, et al. The effect of azoximer bromide (Polyoxidonium?) in patients hospitalized with coronavirus disease (COVID-19): an open-label, multicentre, interventional clinical study. Drugs Context. 2021 Mar 25;10:2020-11-1. doi: 10.7573/dic.2020-11-1.
7. ?Cosentino N, et al. The Impact of COVID-19 Pandemic on Scientific Research: an Upcoming New Wave? J Gen Intern Med. 2022 Aug;37(10):2553-2555. doi: 10.1007/s11606-022-07647-6.
8. ?Yang Y, et al. 'Paperdemic' during the COVID-19 pandemic. Eur J Intern Med. 2023 Feb;108:111-113. doi: 10.1016/j.ejim.2022.09.030.
9. ?Efimov SV, et al. Open-label use of an aliphatic polyamine immunomodulator in patients hospitalized with COVID-19. Drugs Context. 2022 Mar 3;11:2022-1-1. doi: 10.7573/dic.2022-1-1.
10. ?Hardman T. Pointless Science. https://www.dhirubhai.net/pulse/pointless-science-tim-hardman/ 24 Jan 2018.
11. ?Kompier R, et al. Analysis of the safety and immunogenicity profile of an azoximer bromide polymer-adjuvanted subunit influenza vaccine. F1000Res. 2022 Mar 2;11:259. doi: 10.12688/f1000research.75869.2.
12. ?Kostinov MP, et al. Use of immunomodulatory therapy as part of comprehensive treatment of non-severe community-acquired pneumonia and its long-term results. Drugs Context. 2023 Aug 8;12:2022-10-5. doi: 10.7573/dic.2022-10-5.

?

?