Remdesivir can be extremely effective against coronavirus, the case study found

LONDON: Remdesivir may be an extremely effective antiviral against SARS-CoV-2, the virus that causes Covid-19, according to a new single-patient study that contradicts previous research that found the drug had no impact on rates death due to the disease.
Researchers at the University of Cambridge in the United Kingdom who administered the drug to a patient with Covid-19 and a rare immune disorder, noticed a dramatic improvement in his symptoms and the disappearance of the virus.
Scientists had previously based their hope on remdesivir, which was initially developed to treat hepatitis C and later tested for Ebola.
However, the results of large clinical trials were inconclusive, and the World Health Organization (WHO) announced in October that the drug had not significantly reduced mortality rates.
The new study, published in the journal Nature Communications, used a different approach to determine the effects of the drug on Covid-19 in a closely monitored patient.
“There have been several studies that support or question the effectiveness of remdesivir, but some of those performed during the first wave of infection may not be optimal for evaluating its antiviral properties,” said James Thaventhiran of Cambridge University.
The researchers examined the case of a 31-year-old man with XLA, a rare genetic condition that affects the body’s ability to produce antibodies and therefore fight infections.
The patient’s illness began with fever, cough, nausea and vomiting, and on day 19 gave positive results for SARS-CoV-2.
His symptoms persisted and on the 30th he was hospitalized, where he was given oxygen supplementation due to difficulty breathing.
The man’s fever and inflammation of the lungs persisted for more than 30 days, but without causing severe breathing problems or spreading to other organs.
The researchers said this may have been due to its inability to produce antibodies – although antibodies fight infections, they can cause damage and even lead to severe disease.
At first, the patient was treated with hydroxychloroquine and azithromycin, which had a reduced effect, and treatments were stopped on day 34, they said.
The patient then began a ten-day remdesivir course.
The researchers found that within 36 hours, the fever and shortness of breath improved, his nausea and vomiting stopped, adding that the increase in oxygen saturation allowed him to eliminate extra oxygen.
This dramatic clinical response was accompanied by a progressive decrease in levels of C-reactive protein (CRP), a substance produced by the liver in response to inflammation, according to the researchers.
Doctors also saw an increase in the number of his immune cells known as lymphocytes, and chest scans showed that his lung inflammation was cleared, they said.
The patient was discharged on day 43. One week after discharge, the patient’s fever, shortness of breath, and nausea returned.
The man was readmitted to the hospital on day 54 and given oxygen supplementation.
He tested positive for SARS-CoV-2 again, was found to have lung inflammation, and his CRP levels had risen and his lymphocyte count had dropped.
On day 61, the patient began treatment with another ten-day remdesivir cycle, according to the researchers.
The study found that, again, his symptoms improved rapidly, his fever dropped and he was given extra oxygen. His CRP and lymphocyte count has normalized.
After additional treatment with convalescent plasma on days 69 and 70, he was discharged three days later and is no longer symptomatic.
The team found that the patient’s virus levels decreased progressively during his first cycle of remdesivir, corresponding to the improvement of his symptoms.
His virus level rose again, as did his symptoms, when the first cycle of treatment stopped, but the effect of the second cycle of remdesivir was even faster and more complete.
On day 64, he no longer tested positive for coronavirus.
“Our patient’s unusual condition has given us a rare insight into the effectiveness of remdesivir as a treatment for coronavirus infection,” said Nicholas Matheson of the University of Cambridge.
The dramatic response to the drug – to repeated challenges – suggests that it may be an extremely effective treatment, at least for some patients, Matheson added.
Researchers suspect that remdesvir is probably most beneficial when given early in the infection, before the virus can trigger a potentially catastrophic immune response.

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