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Anti-Viral Drug Treats Some Severe Covid-19 Cases

Coronavirus

(Gerd Altmann, Pixabay)

13 Apr. 2020. A report of early use of the anti-viral therapy remdesivir shows most patients with severe cases of Covid-19 infections responded to the drug. Findings from a small group of patients on three continents prescribed remdesivir for compassionate use were reported in Friday’s issue of the New England Journal of Medicine.

The continuing Covid-19 pandemic is creating an urgent need for drugs to treat patients with infections, particularly those with advanced forms of the disease. Remdesivir is a prodrug, an inactive compound that activates when metabolized in organs or cells. In this case, cells take in remdesivir where it reacts and converts to an analogue of adenosine triphosphate, a basic compound in cells performing energy and signaling functions.

Remdesivir is designed by its biotech developer Gilead Sciences to treat a range of viral infections. When encountering infected cells, remdesivir interferes with transcription of viral DNA to RNA, thus reducing production of viral RNA responsible for infections. Preclinical studies in lab monkeys show the drug with promising results against the Ebola virus, but in a clinical trial in Democratic Republic of the Congo in 2019, targeted synthetic antibodies performed far better as a treatment than remdesivir and another drug.

However, remdesivir is also shown to have an effect in preclinical tests against other coronaviruses SARS and MERS, as well as novel coronavirus SARS-Cov-2, and thus is being tested in clinical trials with Covid-19 patients. Gilead Sciences reports the drug is currently in six sets of trials in patients with mild to severe forms of the disease. And in clinical studies so far, remdesivir is shown to be safe with most patients.

The New England Journal of Medicine paper reports on compassionate use of remdesivir in severe cases of Covid-19 infections, where other treatments are not working. Gilead Sciences says it began receiving requests for compassionate use of remdesivir on 25 January 2020, and by 7 March, approved 61 requests in the U.S., Canada, Europe, and Japan. Of those cases, clinicians treating seven patients did not provide data after the treatments and a dosing error was reported in one case.

Of the remaining 53 patients, 34 were receiving mechanical ventilation or extracorporeal membrane oxygenation, a technique to circulate blood through an artificial lung device back into the blood stream. Patients received remdesivir injections for 10 days, 200 milligrams on the first day and 100 milligrams in each of the next nine days.

The results show after a median follow-up of 18 days, 36 or two-thirds of the patients showed improvements in breathing to reduce their need for oxygen support, and nearly half, 25 of 53, were discharged. However, seven patients died, six of whom were receiving mechanical ventilation. Most (60%) of patients showed some adverse effects, with nearly a quarter (23%) reporting serious effects, including, septic shock, kidney injuries, low blood pressure, and multiple organ failures. The serious adverse effects were found in patients receiving mechanical ventilation. Four patients had to discontinue the treatments.

The authors say the results indicate favorable signs for remdesivir in that two-thirds of the patients improved their conditions, and the mortality rate of 13 percent is lower than rates of 22 percent or higher found in clinical trials among severely ill Covid-19 patients. Nonetheless, say the authors, clinical trials with larger samples and placebo groups are still needed to make an informed judgement about remdesivir.

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