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Are Nasal Sprays The Future Of COVID-19 Vaccination? 20 New Drugs And 8 Nasal Sprays For COVID-19 Under Trial

During the early months of 2021, reports of nasal sprays for COVID-19 were making rounds. In June, PM Narendra Modi addressed the nation, highlighting that research on developing intranasal vaccines as an alternative to injected vaccines are underway.

Nasal vaccine or intranasal vaccine is administered through the nose instead of a needle (injected vaccines). These types of vaccines directly deliver the dose (of medicine) to the respiratory pathway, just like a nasal spray.

On 21 August 2021, a group of scientists from the Washington University School of Medicine published a paper stating the development of a nasal vaccine that targets the SARS-CoV-2 virus [1].

Intranasal Vaccine AKA Nasal Spray For COVID-19: What You Need To Know

The nasal spray for COVID-19 is developed from llama antibodies and could potentially provide protection against infectious diseases [2]. A smaller form of antibody developed by llamas and camels could effectively target the SARS-CoV-2 virus.

Here is everything we know so far about the possible introduction of nasal sprays for COVID-19:

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1. Studies on intranasal vaccines:

  • A number of hospitals in India have started discussions on beginning nasal spray trials to treat COVID-19 patients.
  • In September 2021, another study by researchers at Cleveland Clinic showed that patients who used intranasal corticosteroids prior to COVID-19 illness were 22 per cent less likely to be hospitalized, 23 per cent less likely to be admitted to the intensive care unit and 24 per cent less likely to die from COVID-19 during hospitalization [3].
  • The medicine department of Government Medical College and Hospital (GMCH) in Nagpur had received the approval for human trials of nitric oxide nasal spray on COVID-19 patients [4].
  • Glenmark Pharmaceuticals also plans to test its upcoming nitric oxide nasal spray (NONS) that it has licensed from a Canadian Biotech firm as a preventive measure for COVID-19 [5].
  • According to a study by the National Institute of Allergy and Infectious Diseases (NIAID), administering Oxford/AstraZeneca COVID-19 vaccine through the nose reduced viral shedding [6].
  • Another study published in Health Agencies Update revealed that the University of Oxford researchers are now conducting an open-label clinical trial of the intranasal vaccine in healthy human volunteers [7].
  • A study by researchers at the Queen Mary University of London developed pHOXWELL - a nasal spray developed by biotech company pHOXBIO, which has been shown to reduce SARS-CoV-2 infection by 63 per cent [8].
  • According to a study by the researchers at the University of São Paulo's Biomedical Sciences Institute, a saltwater solution (spray) may help stop the SARS-CoV-2 virus in its tracks. The study also added that while the saline may prevent the virus from replicating, it does not offer full protection against infection or is a cure for COVID-19 [9].
  • Note: A reduced viral replication means reducing the severity of the disease and the inflammatory response [10].

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2. Relevance of intranasal vaccine:

  • Steroid nasal sprays have the capacity to lower certain receptors on the cells of the nose that the COVID-19 virus latches on to infect.
  • Researchers of one study compared the injected and the intranasal vaccines (in hamsters) and while both methods produced high antibody levels, the nasal spray produced more than the injection.
  • Nasal vaccines, if proven to be effective, will be affordable by all sections of society, unlike the antibody cocktail [11]. Also, NONS will also be priced lower in India compared to global benchmark pricing.
  • Studies have shown that nasal spray offers 6-8 hours of protection with just two sprays per nostril and is designed to be effective against other airborne respiratory viruses as well [12].
  • The saline solution spray of sodium chloride at 1.1 per cent reduced replication of the virus by 88 per cent in tests of infected lung cells.
  • The nasal spray vaccines are said to have an immediate effect on the virus in an infected person's mucus and trigger the production of an antibody known as immunoglobulin A, which can block infection.
  • Nasal vaccines don't need refrigeration and don't need to be administered by health professionals, and people can use it, sitting in the comfort of one's own home.
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3. Nitric oxide for COVID-19:

  • A molecule produced by the human body, nitric oxide is essential for an individual's overall health as it promotes blood circulation and allows the nutrients and oxygen to pass through the body [13].
  • Nitric oxide nasal spray or NONS demonstrated prolonged viral clearance in COVID-19 patients, and the virus was no longer viable after 15 days post onset of symptoms.
  • The NONS prevents mild COVID infection from progressing to moderate/severe disease, as per the findings in a phase II trial study by the GMCH.
  • As per the manufacturer (Glenmark Pharmaceuticals), those who tested RT-PCR positive up to 48 hours ago can get themselves cured by using this spray six times a day, for three days - however, this is yet to be proven with human trials.
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4. NONS human trials:

  • The COVID-19 patients, who enrol for the human trials will have to undergo a fresh RT-PCR test which will determine the amount of viral load. If there is enough viral load, the patients will be given the nasal spray which has to be used six times a day (after 2-hour intervals) for three days.
  • Fresh RT-PCR will be conducted every day during these three days and on the 8th day of the treatment to know the viral load.
  • As per the phase II trial, the nasal spray (produced by Glenmark) had shown a 99 per cent reduction in three days' time.
  • In the first 24 hours, NONS reduced the average viral load by around 95 per cent and then by more than 99 per cent within 72 hours.
  • Bharat Biotech also began the phase II/III clinical trials of its intranasal vaccine by September end [14].
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Eight COVID-19 Vaccine Nasal Sprays Under Clinical Trials

The World Health Organization said that clinical trials are underway to evaluate eight nasal spray vaccines for treating and preventing COVID-19 [15].

  • 7 of the 100 COVID-19 vaccines in clinical trials are nasal sprays.
  • Russia has begun testing a nasal spray of its COVID-19 vaccine in children aged 8-12 years.
  • China's Xiamen University, the University of Hong Kong and Beijing Wantai Biological Pharmacy have completed phase-2 trials.
  • A Japanese pharmaceutical company, Shionogi announced that they will soon begin the clinical trial for nasal sprays.
  • 20 New Drugs For COVID-19 Under Trial

    • Merck and Ridgeback Biotherapeutics' oral antiviral treatment molnupiravir, which has been shown to reduce the risk of hospitalisation or death by around 50 per cent, has been conducting trials in India [16].
    • Ahmedabad-based Zydus Cadila claims to have developed a cocktail treatment neutralising monoclonal antibodies.
    • Pfizer's Ritonavir and PF-07321332 (antiviral drug) has been given a go-ahead for phase II and III trials.
    • NIPER's Life Viro Treat, a nebuliser-based therapy for respiratory viral infection, is also being tested.
    • Silmitasertib, a drug that acts on the protein kinase CK2 pathway is said to have a potential effect against COVID-19.
    • CSIR has been conducting Phase III trials of Umifenovir (a drug used for the treatment of influenza in China and Russia) [17].
    • Other lists of drugs that have been approved for trials or are in the process of approval include CBCC Global Research's Niclosamide, Gufic Biosciences' Thymosin α-1 injection, Sun Pharma's Purified aqueous extract of Cocculus hirsutus, and Syngene's Imatinib Mesylate.
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On A Final Note…

The human nose has the highest number of receptors than the lungs or the airways, therefore the introduction of an intranasal vaccine could prove to be more effective than injected vaccines. Researchers and scientists point out that while it is too soon to think of intranasal vaccines as a cure for COVID-19, there are possibilities and more randomised clinical trials are necessary for the same.

Warning Note: Despite the findings, the steroid nasal sprays should not be used to prevent or treat COVID-19, the health system said.

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