- The Washington Times - Wednesday, July 1, 2020

Dr. David Fajgenbaum knows firsthand how using a repurposed drug can save lives: He found an existing medication that rescued his own life from an immunity disorder he acquired in medical school.

Now the rare disease researcher — a graduate of Georgetown University — is applying his life lesson in the hunt for a treatment for COVID-19.

The Castleman Disease Collaborative Network (CDCN), which Dr. Fajgenbaum co-founded, is compiling a database of off-label and experimental drugs being used to treat COVID-19 patients in hopes of identifying treatment options with the most promise. To date, his team has compiled data for more than 150 drugs and 20,000 patients.

“That’s mind-blowing, when you think that nothing is approved, but doctors and researchers are trying so hard to find drugs that could help that things are just getting thrown at COVID-19 patients,” Dr. Fajgenbaum, now an immunologist at the University of Pennsylvania, told The Washington Times. “And before our database, none of this had been captured.”

When he was a sophomore at Georgetown, his mother died of brain cancer, which prompted him to found a group for grieving students called Ailing Mothers and Fathers. Already on the pre-med track, he made it his new goal to “chase after diseases.”

But in his third year at the Perelman School of Medicine of the University of Pennsylvania, he came face to face with his own disease: a condition called idiopathic multicentric Castleman disease (iMCD), whose cause is still unknown and which brought him to the brink of death five times in a few short years.

Victims of Castleman disease experience their immune system going into overdrive due to “cytokine storms” in which the body attacks its own cells instead of the virus.

Dr. Fajgenbaum says such storms are being found in the most severely ill COVID-19 patients.

Dr. Fajgenbaum, 35, says he felt he didn’t have time to wait for a drug for Castleman to be developed from scratch, so he founded the CDCN with the aim of finding an existing drug that could help. The network’s research eventually identified a drug called sirolimus, which was used for kidney transplants.

It worked. July 5 will mark 6½ years of being in remission, Dr. Fajgenbaum says. The drug also helped others who suffered from iMCD.

Dr. Fajgenbaum has an “army” of roughly 40 volunteers around the country working on the CDCN’s CORONA Project. They scan publications for new studies, input the data and analyze it.

He has shared the database with the Food and Drug Administration, which asked him to add specific data fields, such as whether a repurposed drug appears to result in improvement or deterioration.

One of the most promising drugs at the moment is the corticosteroid dexamethasone. A British study determined that COVID-19 patients on ventilators had a 35% better survival rate when administered dexamethasone.

The U.S. added dexamethasone to its coronavirus treatment guidelines, Secretary of Health and Human Services Alex Azar said Friday.

Dr. Fajgenbaum says dexamethasone — an established drug that’s cheap and widely available — is the sort of discovery he hoped the CORONA Project would find. The project’s data showed that about 20% of hospitalized patients already have received either dexamethasone or one of its “cousin” steroids.

“It’s possible … that many of those patients may have had their lives saved by this drug, and we didn’t even know it at the time,” he said.

Some possible treatments discussed most in the news — remdesivir and hydroxychloroquine — are showing mixed results. After a promising first study, follow-ups with randomized, controlled trials suggest that hydroxychloroquine provides no benefit, Dr. Fajgenbaum notes.

It could turn out that it’s helpful to a certain subgroup or demographic of coronavirus patients, though, and the doctor says “dozens” more studies have been launched.

“I’ve not closed that book whatsoever,” he said. “We need to continue to follow the data.”Remdesivir “probably” has a beneficial effect, but one smaller than dexamethasone, Dr. Fajgenbaum adds.

“We should all be cheering for every drug,” he said. “We should want every drug to work. But we should also be really rigorous. If it doesn’t look like it’s working — as physician-scientists, as patients — we want to make sure we find the right answers.”

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