A 120-year-old drug is about to be put to the test as a possible treatment for covid-19. This week, researchers from the UK announced they would start including aspirin as one of the treatments studied in the ongoing RECOVERY trial — one of the largest and most influential clinical trials conducted during the pandemic. They hope that aspirin’s well-known anti-clotting properties can help seriously ill patients avoid death.
The RECOVERY trial has so far involved over 16,000 patients hospitalized with covid-19 in the UK. These patients have been randomised to receive standard care alone or a variety of experimental treatments in addition to standard care. RECOVERY was the first major trial to find evidence that common steroids can be lifesaving for severe cases; the trial also found little to no evidence that other treatments, including the antimalarial hydroxychloroquine, did much of anything. Its findings have greatly shaped the current standard of treatment for covid-19 patients.
RECOVERY has continued to test other promising options for covid-19, the latest now being aspirin. An estimated 2,000 patients are expected to receive a dose of aspirin, alongside standard care, and they’ll be compared to those receiving no extra care. People with a known allergy to aspirin or recent major bleeding will be excluded from the trial. The main outcome studied will be people’s mortality rate after 28 days.
Many severe complications of covid-19 are thought to involve blood-clotting problems. Some researchers have argued, and at least one recent study has also suggested, that aspirin use could lead to greater survival among covid-19 patients. But it usually takes data from large-scale randomised and controlled clinical trials for doctors to widely adopt a new treatment into their arsenal — data that RECOVERY will hopefully provide.
“Aspirin is widely used to prevent blood clots in many other conditions, including heart attack, stroke, and pre-eclampsia in pregnant women,” said Martin Landray, a researcher at the University of Oxford and one of the project’s lead scientists, in the announcement of the new arm of the trial Friday. “But enrolling patients in a randomised trial such as RECOVERY is the only way to assess whether there are clear benefits for patients with covid-19 and whether those benefits outweigh any potential side effects such as the risk of bleeding.”
Current treatments, such as steroids, only provide a modest life-saving benefit for the most severe cases, and there are still no clear-cut treatments that have proven effective at preventing moderate cases from worsening. So any help that aspirin could provide is sorely needed, especially as the pandemic has badly worsened throughout the world. This week alone has seen record case numbers in places like the U.S., while the resurgence of the illness throughout Europe has contributed to new lockdowns and some of the deadliest days of this entire pandemic worldwide.
That said, it will likely take months before results on aspirin will emerge from RECOVERY. Other treatments currently being tested in the trial include the antibiotic azithromycin, the anti-inflammatory tocilizumab, and an experimental lab-made antibody cocktail developed by the company Regeneron.