Remdesivir can be highly effective against coronavirus, according to case studies

LONDON: Remdesivir may be a potent antiviral agent against SARS-CoV-2, the virus that causes Covid-19. This emerges from a new single patient study that contradicts previous research that found the drug had no effect on the death rate from the disease.
Researchers at the University of Cambridge in the UK, who gave the drug to a patient with Covid-19 and a rare immune disease, saw a dramatic improvement in his symptoms and the disappearance of the virus.
Scientists previously had hoped for remdesivir, which was originally developed to treat hepatitis C and then tested against Ebola.
However, the results of large clinical trials were inconclusive, and the World Health Organization (WHO) announced in October that the drug did not significantly reduce death rates.
The new study, published in the journal Nature Communications, used a different approach to determine the drug’s effect on Covid-19 in a closely monitored patient.
“There have been several studies proving or questioning the effectiveness of remdesivir, but some of the studies done during the first wave of infections may not be optimal for assessing its antiviral properties,” said James Thaventhiran of Cambridge University.
The researchers looked at the case of a 31-year-old man with XLA, a rare genetic disorder that affects the body’s ability to produce antibodies to fight infections.
The patient’s illness began with fever, cough, nausea, and vomiting and on day 19 he tested positive for SARS-CoV-2.
His symptoms persisted and on the 30th day he was admitted to the hospital, where he was given supplemental oxygen due to difficulty breathing.
The fever and inflammation of the man’s lungs lasted for more than 30 days without causing severe breathing problems or spreading to other organs.
The researchers said this could be due to his inability to produce antibodies – while antibodies fight infections, they can also harm the body and even lead to serious illness.
First, the patient was treated with hydroxychloroquine and azithromycin, which had little effect, and the treatments were stopped on day 34, they said.
The patient then began a ten day remdesivir course.
The researchers found that within 36 hours his fever and shortness of breath improved, and his nausea and vomiting stopped.
This dramatic clinical response, according to the researchers, was accompanied by a progressive decrease in C-reactive protein (CRP) levels, a substance made by the liver in response to inflammation.
Doctors also saw an increase in the number of his immune cells known as lymphocytes, and breast exams showed his pneumonia was improving, 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 hospitalized again on day 54 and was given supplemental oxygen.
He tested positive for SARS-CoV-2 again, diagnosed pneumonia, and had increased CRP levels and decreased lymphocyte counts.
On day 61, the patient began treatment with another 10-day remdesivir treatment, the researchers said.
The study found that his symptoms again quickly improved, his fever decreased, and he was deprived of additional oxygen. His CRP and lymphocyte counts 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 progressively decreased during his first treatment with remdesivir, reflecting improvement in his symptoms.
His virus levels rose again, as did his symptoms when the first course of treatment was abandoned, but the effect of the second course of remdesivir was even faster and more complete.
On day 64, he no longer tested positive for the coronavirus.
“Our patient’s unusual condition gave us a rare glimpse into the effectiveness of remdesivir in treating coronavirus infections,” said Nicholas Matheson of the University of Cambridge.
“The dramatic response to the drug – with repeated exposure – suggests that it may be a highly effective treatment for at least some patients,” added Matheson.
The researchers suggest that remdesvir is likely most beneficial when given at the onset of infection, before the virus can trigger a potentially catastrophic immune response.