Remdesivir: a demonstrated efficacy in the treatment of patients with COVID-19

The recently published a clinical trial that confirmed the efficacy of remdesivir in shortening the healing time in patients with Covid-19 and a lower respiratory tract infection.

This new study overturns the results of previous research, conducted by a group of Chinese researchers, published in The Lancet, which had found no benefits associated with this treatment in adult patients hospitalized for severe COVID-19.

The remdesivir

Remdesivir is a prodrug. Its active metabolite, analogue of adenosine nucleoside triphosphate, acts by interfering with the action of viral-dependent RNA polymerase, inducing a decrease in viral RNA production. It is classified as a direct acting antiviral agent.

In vitro it has shown to be effective in inhibiting the SARS-CoV-1 virus and that of Middle East respiratory syndrome. Due to these precedents, it immediately became a candidate as a possible therapeutic agent also for the emerging pandemic of the new coronavirus Sars-CoV-2.

Remdesivir in the treatment of COVID-19: the study

This new study, carried out in a double-blind, randomized, placebo-controlled design, remdesivir was administered intravenously to adults hospitalized with Covid-19 and with evidence of lower respiratory tract infection.

The patient group assigned to active treatment received a loading remdesivir dose of 200 mg on the first day, followed by 100 mg daily for up to a further 9 days. Patients assigned to the control group received a placebo for up to 10 days.

The primary outcome of the trial was the time to recovery from disease, defined as the first day, during the 28 days following enrollment, in which a patient met a set of criteria that established substantial recovery or a clear sign of improvement.

In total, 541 patients were assigned to the remdesivir group and 521 to the placebo group; overall they had an average age of 59 years.

Remdesivir in the treatment of COVID-19: healing is accelerated

The results of the study showed that patients who received remdesivir recovered from their disease in a median of 10 days. In the subjects treated with placebo, recovery was achieved in 15 days.

Mortality estimates indicated a rate of 6.7% with remdesivir and 11.9% with placebo by day 15 and 11.4% with remdesivir and 15.2% with placebo by day 29.

Regarding treatment safety, serious adverse events were reported in 24.6% of remdesivir-treated patients and 31.6% of those included in the placebo group.

Remdesivir in the treatment of COVID-19: reduced mortality

A few months after the onset of the COVID-19 pandemic, a new drug to fight the disease is officially available. Among the various medications used to fight the new coronavirus, remdesivir immediately proved to be a promising drug, but only now, with the results of this trial published, its use is fully justified.

Remdesivir appears to provide two important benefits. First, it reduces the duration of the disease, accelerating the healing process. The second aspect, perhaps the most important, significantly reduces mortality: by 45% on day 15 and by 73% on day 29. However, the authors of the study warn that in this context the differences in mortality between groups varied considerably, according to the underlying severity of the disease.

This drug has never been used in patients in the early stages of the disease or with mild forms of COVID-19. For this reason, its use is reserved, at least for the moment, for patients with significant forms, hospitalized, and in whom there is evidence of an ongoing lung infection.

It should be remembered that all antiviral drugs are burdened with more or less relevant side effects. In particular, the most common adverse effects of remdesivir include respiratory failure, low albumin levels, hypopotassemia, anemia, and thrombocytopenia.

In this new study, there was no excess of adverse events in the active treatment group, but overall, potentially treatment-related effects were noted in some cases.

More precisely, there were cases of severe respiratory failure in 8.8% of patients treated with remdesivir, including acute respiratory failure and the need for intubation, and in 15.5% of patients included in the placebo group.

Following precise indications, remdesivir can substantially help to fight the new coronavirus, accelerating healing and reducing the mortality of the disease, that was so relevant in the first phase of the pandemic.

This post is also available in: Chinese (Simplified)

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