Host-targeted antivirals against SARS-CoV-2 in clinical development - Prospect or disappointment?

Antiviral Res. 2025 Mar:235:106101. doi: 10.1016/j.antiviral.2025.106101. Epub 2025 Feb 7.

Abstract

The global response to the COVID-19 pandemic, caused by the novel SARS-CoV-2 virus, has seen an unprecedented increase in the development of antiviral therapies. Traditional antiviral strategies have primarily focused on direct-acting antivirals (DAAs), which specifically target viral components. In recent years, increasing attention was given to an alternative approach aiming to exploit host cellular pathways or immune responses to inhibit viral replication, which has led to development of so-called host-targeted antivirals (HTAs). The emergence of SARS-CoV-2 and COVID-19 has promoted a boost in this field. Numerous HTAs have been tested and demonstrated their potential against SARS-CoV-2 through in vitro and in vivo studies. However, in striking contrast, only a limited number have successfully progressed to advanced clinical trial phases (2-4), and even less have entered clinical practice. This review aims to explore the current landscape of HTAs targeting SARS-CoV-2 that have reached phase 2-4 clinical trials. Additionally, it will explore the challenges faced in the development of HTAs and in gaining regulatory approval and market availability.

Keywords: COVID-19; Drug repurposing; Host-targeted antivirals; SARS-CoV-2; Therapeutic strategies; Virus-host interaction.

Publication types

  • Review

MeSH terms

  • Animals
  • Antiviral Agents* / pharmacology
  • Antiviral Agents* / therapeutic use
  • COVID-19 / virology
  • COVID-19 Drug Treatment*
  • Clinical Trials as Topic
  • Drug Development
  • Humans
  • SARS-CoV-2* / drug effects
  • Virus Replication / drug effects

Substances

  • Antiviral Agents