Conclusions and Future Directions
Evidence has accumulated that niclosamide is a multi-functional drug
that can modulate several signaling pathways and biological processes.
It has shown pre-clinical activity in many disease models, from cancer
and metabolic diseases to various infections. The leading causes of
mortality in COVID-19 patients are an exaggerated immune response, as
well as secondary bacterial infections and the development of ARDS.
Niclosamide can function both as an anti- anti-bacteriostatic agent as
well as an immunomodulator, thus it has unique advantages over other
agents currently being tested in the COVID-19 arena.
More importantly, niclosamide’s broad-spectrum antiviral properties and
potent inhibition of SARS-CoV-2 means it can be developed rapidly as a
cost-effective therapeutic approach against COVID-19 and holds the
promise of widespread utilization as a primary or adjunctive agent.
Niclosamide’s use could be further extended to other viral respiratory
infections with a high unmet medical need, such as rhinovirus, influenza
virus and respiratory syncytial virus. The reformulation of niclosamide
into a nebulised and nasal route has the potential to provide the drug
at therapeutic concentrations to the site of viral replication and
disease and thereby minimise systemic toxicity. We anticipate that the
results of the upcoming clinical trials of niclosamide in COVID-19,
including the TACTIC-E trial, will prove to be an important milestone in
managing the pandemic globally.