A new study performed in the United Kingdom demonstrated giving remdesivir to patients with COVID-19 and a rare immune disorder, and observing a dramatic improvement in his symptoms and the disappearance of the virus. Their work is published in Nature Communications.
Remdesivir, had been developed to treat hepatitis C and tested against Ebola. However, results from large clinical trials have been inconclusive, and in early October the World Health Organization (WHO) announced that the drug did not significantly reduce mortality rates. However, a clinical team has now used a different approach to determine the effects of the drug on COVID-19 in a closely monitored patient.
Dr. James Thaventhiran of the MRC Toxicology Unit at the University of Cambridge stated, "There have been different studies supporting or questioning remdesivir's effectiveness, but some of those conducted during the first wave of infection may not be optimal for assessing its antiviral properties.
"Mortality is due to a combination of factors, likely including unchecked viral replication and, importantly, the response of the immune system. A clinical trial that looks only at remdesivir's impact on mortality will have difficulty distinguishing between these two factors. This limits our ability to ask the simple question: how good is remdesivir as an antiviral?"
Researchers at the University of Cambridge and Barts Health investigated the case of a 31-year-old man with XLA, a rare genetic condition that affects the body's ability to produce antibodies and hence fight infection. The patient's symptoms started with fever, cough, nausea, and vomiting, and on day 19 he tested positive for SARS-CoV-2. His symptoms persisted and on day 30 he was admitted to hospital, where he was given supplemental oxygen due to breathing difficulties. His fever and inflammation of the lungs persisted for longer than 30 days, but without causing severe breathing problems or spreading to other organs. The researchers say this may have been due to his inability to produce antibodies - although antibodies fight infection, they can also cause damage to the body and even lead to severe disease.
He was first treated with hydroxychloroquine and azithromycin, which had little effect, and the treatments were stopped on day 34. Then a ten-day course of remdesivir was started and within 36 hours, his fever and shortness of breath had improved and his nausea and vomiting ceased. Rising oxygen saturation allowed him to be taken off supplemental oxygen. The patient was discharged on day 43.
A week after discharge, symptoms returned, including shortness of breath. He was readmitted to the hospital on day 54 and given supplemental oxygen. He again tested positive for SARS-CoV-2, was found to have lung inflammation, and his CRP levels had increased and his lymphocyte count fallen.
On day 61, the patient started treatment with remdesivir for ten days. Once again, his symptoms improved rapidly, his fever dropped and he was taken off supplemental oxygen. His CRP and lymphocyte count normalized. Following 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 fell progressively during his first course of remdesivir, corresponding with the improvement in his symptoms. His virus levels increased again, as did his symptoms, when the first course of the treatment ceased, but the effect of the second course of remdesivir was even more rapid and complete. By day 64, he was no longer testing positive for the coronavirus.
Dr. Nicholas Matheson of the Cambridge Institute of Therapeutic Immunology and Infectious Disease (CITIID) at the University of Cambridge commented, "Our patient's unusual condition gave us a rare insight into the effectiveness of remdesivir as a treatment for coronavirus infection. The dramatic response to the drug - on repeated challenge - suggests that it can be a highly effective treatment, at least for some patients."