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.