The Basin Report

Trials Show Drug Accelerates Recovery

The drug Remdesivir has drawn a lot of recent interest amidst the coronavirus pandemic.  Clinical trials show it may indeed accelerate the recovery from advanced COVID-19.

Remdesivir, developed by Gilead Sciences Inc., is an investigatory broad-spectrum antiviral treatment administered via daily infusion for 10 days. It has shown promise in animal models for treating SARS-CoV-2 (the virus that causes COVID-19) infection and has been examined in various clinical trials. It has also been used as a treatment for Ebola virus disease and Marburg virus infections.

Remdesivir is an antiviral medication developed by the American bio-pharmaceutical company. It is a nucleotide analog, specifically an adenosine analogue, which inserts into viral RNA chains, causing their premature termination. It is being studied as a possible post-infection treatment for COVID-19 and on April 29, the US National Institute of Allergy and Infectious Diseases announced the preliminary results of a study showing Remdesivir cut the recovery time from 15 to 11 days with a high level of certainty.

Hospitalized patients with advanced COVID-19 and lung involvement who received Remdesivir recovered faster than similar patients who received placebo, according to a preliminary data analysis from a randomized, controlled trial involving 1063 patients, which began on February 21. The trial (known as the Adaptive COVID-19 Treatment Trial, or ACTT), sponsored by the National Institute of Allergy and Infectious Diseases (NIAID), part of the National Institutes of Health, is the first clinical trial launched in the United States to evaluate an experimental treatment for COVID-19.

Preliminary results indicate that patients who received Remdesivir had a 31% faster time to recovery than those who received placebo (p<0.001). Specifically, the median time to recovery was 11 days for patients treated with Remdesivir compared with 15 days for those who received placebo. Results also suggested a survival benefit, with a mortality rate of 8.0% for the group receiving Remdesivir versus 11.6% for the placebo group (p=0.059).

So far, Remdesivir was viewed as the most likely promising treatment for COVID-19 by Johns Hopkins University. On April 29, a study by the US National Institute of Allergy and Infectious Diseases was announced to show an hastened recovery and a possible decrease in mortality rate.  In March, a small trial of Remdesivir in rhesus macaque monkeys with COVID-19 infections found that it prevents disease progression.

Remdesivir is a prodrug that metabolizes into its active form GS-441524. Though in some viruses, such as the respiratory syncytial virus but not Ebola virus, it causes the RNA-dependent RNA polymerases to pause, its predominant effect is to induce an irreversible chain termination. Unlike with many other chain terminators, this was not mediated by preventing addition of the immediately subsequent nucleotide, but is instead delayed, occurring after five additional bases have been added to the growing RNA chain.

One of the biggest advantages, for obvious reasons, for utilizing the drug is it currently being produced in the United States, instead of China or elsewhere.


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