Infectious Disease
Remdesivir accelerates viral clearance in patients with early, symptomatic COVID-19
August 26, 2023
2 min read
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Disclosures:
The authors report no relevant financial disclosures.
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Key takeaways:
- Treatment with IV remdesivir accelerated viral clearance in patients with early symptomatic COVID-19.
- Remdesivir and repeated oropharyngeal swabbing were well tolerated.
If given to patients with early and symptomatic COVID-19, treatment with remdesivir can accelerate the rate of viral clearance in oropharyngeal swabs over 1 week, researchers found.
“PLATCOV, the platform study which is assessing a number of different COVID-19 antiviral therapeutics including remdesivir, was conceived because we saw that several years into the pandemic, there remained uncertainty as whether or not many drugs were antiviral in humans,” William H. K. Schilling, MBBS, research physician at the Mahidol Oxford Tropical Medicine Research Unit in Bangkok, Thailand, told Healio.
Patients with early, symptomatic COVID-19 who were treated with remdesivir had accelerated rates of viral clearance measured by oropharyngeal swabs. Image: Adobe Stock.
“This uncertainty often led to conflicting views and recommendations. This seemed like a fairly fundamental gap in our understanding and one which we could try and help with,” Schilling said.
In the case of remdesivir, the optimal timing after SARS-CoV-2 infection for the treatment and the length of time for which it should be use have been subject of debate and study since early in the COVID-19 pandemic.
The FDA approved remdesivir this month as a first-line antiviral COVID-19 treatment for people with all stages of liver disease based on a phase 1 trial.
To assess treatments, Schilling and colleagues conducted a multicenter open-label, controlled, adaptive, pharmacometric platform trial of low-risk adult patients with early symptomatic COVID-19.
According to the study, these patients were randomly assigned to receive one of eight treatments, although preliminary data shared in this study included only IV remdesivir (200 mg, followed by 100 mg daily for 5 days) or no study drug.
The primary outcome of the study was the rate of SARS-CoV-2 clearance using standardized duplicate oropharyngeal swabs. The researchers estimated rates of clearance using a linear model fit to the daily log10 viral densities from the first 8 days following treatment randomization.
A total of 131 patients were enrolled in the two study arms — 67 of whom received remdesivir and 64 no study drug. Approximately 18 swab samples were taken per patient, totaling 2,356 quantitative PCRs across the study.
Using the linear model, researchers determined that remdesivir accelerated mean estimated viral clearance by 42% (95% credible interval, 18%-73%) compared with the no study drug.
Additionally, the study showed that both remdesivir and repeated oropharyngeal swabbing were well tolerated with no treatment-related serious adverse events being reported.
“It was already known since early 2022 that remdesivir was clinically beneficial if given early, although that study was not able to show the antiviral effect,” Schilling said. “The finding of greater implication is that it is possible to determine if a drug is antiviral or not in humans through regular swabbing, quickly and with relatively small numbers of patients.”
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