Repurposed Medicines for Viruses With Epidemic or Pandemic Potential: A Horizon Scan

Sola Akinbolade; Rhiannon Potter; Alex Inskip; Jane Nesworthy; Kirsti Brock; Gill Norman

Abstract: ORIGINAL ARTICLE Repurposed Medicines for Viruses With Epidemic or Pandemic Potential: A Horizon Scan Sola Akinbolade | Rhiannon Potter | Alex Inskip | Jane Nesworthy | Kirsti Brock | Gill Norman National Institute for Health and Care Research (NIHR) Innovation Observatory, Population Health Sciences Institute, Faculty of Medical Sciences, Newcastle University, Newcastle, UK [Sola Akinbolade (sola.akinbolade@ncl.ac.uk)](mailto:sola.akinbolade@ncl.ac.uk) Correspondence: Received: 16 February 2026 | Revised: 16 February 2026 | Accepted: 11 May 2026 Keywords: direct- acting antivirals | drug repositioning | drug repurposing | emerging viral infections | epidemic preparedness | horizon scanning | host- targeted therapies | pandemic preparedness | viruses ABSTRACT Viruses such as Ebola, Marburg, influenza, mpox, MERS- CoV, SARS- CoV, and SARS- CoV- 2 may be considered pathogens of epidemic or pandemic concern. Developing novel antiviral medicines can be time- consuming and resource intensive. Repurposing existing medicines with known or potential antiviral activity offers a faster, cost- effective strategy to expand treatment options during public health emergencies. This scan aimed to map current investigational activity involving repurposed medicines for these viruses. A horizon scanning approach was employed, starting with a targeted search in Embase followed by a systematic search of Clini calTr ials. gov to identify developmental stages of relevant technologies. Eligible technologies included UK- or EUlicensed medicines being investigated for antiviral use, while vaccines, unlicensed medicines, and treatments already approved for the target viruses were excluded. From the literature, 196 repurposed technologies were identified, and the expanded search on the clinical trials registry revealed 58 technologies in active clinical development. Interventional trial activity was limited to influenza and SARS- CoV- 2, with 29 technologies for SARS- CoV- 2 and two influenza technologies advancing to phase III evaluation. For other viruses, candidate repurposed technologies were identified only at preclinical or exploratory stages. Frequently investigated pharmacological classes included direct- acting antivirals, immunomodulators, and anti- inflammatory agents. While repurposing represents a potentially rapid strategy for therapeutic deployment, inclusion in this horizon scan does not imply clinical efficacy. Rigorous preclinical validation, pharmacokinetic feasibility assessment, and mechanistic confirmation remain essential before clinical translation. 1 | Introduction Viruses are microscopic organisms capable of infecting living hosts. While not all viruses are contagious, those that are capable of transmission can spread rapidly within human populations. Some viruses are considered potential epidemic or pandemic threats because of their high transmissibility and ability to cause significant illness and/or death [1]. A virus cannot replicate outside of living cells of a host organism; however, once it infiltrates a host cell, it uses components within the host cell to multiply, often killing the host cell and causing damage to the host organism [2]. Viruses contain either an RNA (ribonucleic acid) or DNA (deoxyribonucleic acid) genome surrounded by a virus- coded protein coat [2]. Genetic changes or mutations in these genetic materials can result in new functions or..

DOI record: { "DOI": "10.1002/prp2.70271", "ISSN": [ "2052-1707", "2052-1707" ], "URL": "http://dx.doi.org/10.1002/prp2.70271", "abstract": "ABSTRACT\n \n Viruses such as Ebola, Marburg, influenza, mpox, MERS‐CoV, SARS‐CoV, and SARS‐CoV‐2 may be considered pathogens of epidemic or pandemic concern. Developing novel antiviral medicines can be time‐consuming and resource intensive. Repurposing existing medicines with known or potential antiviral activity offers a faster, cost‐effective strategy to expand treatment options during public health emergencies. This scan aimed to map current investigational activity involving repurposed medicines for these viruses. A horizon scanning approach was employed, starting with a targeted search in Embase followed by a systematic search of\n ClinicalTrials.gov\n to identify developmental stages of relevant technologies. Eligible technologies included UK‐ or EU‐licensed medicines being investigated for antiviral use, while vaccines, unlicensed medicines, and treatments already approved for the target viruses were excluded. From the literature, 196 repurposed technologies were identified, and the expanded search on the clinical trials registry revealed 58 technologies in active clinical development. Interventional trial activity was limited to influenza and SARS‐CoV‐2, with 29 technologies for SARS‐CoV‐2 and two influenza technologies advancing to phase III evaluation. For other viruses, candidate repurposed technologies were identified only at preclinical or exploratory stages. Frequently investigated pharmacological classes included direct‐acting antivirals, immunomodulators, and anti‐inflammatory agents. While repurposing represents a potentially rapid strategy for therapeutic deployment, inclusion in this horizon scan does not imply clinical efficacy. 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