Published on Monday, Dec. 14, in the journal Nature Communications, the latest study raises questions about previous studies that found remdesivir had no impact on death rates from the disease.
The study describes how a patient with COVID-19 and X-linked agammaglobulinemia (XLA), a rare, inherited immunodeficiency disorder, showed significant improvement when treated with remdesivir.
Prior to being treated, the patient showed moderate but persistent symptoms of COVID-19 due to his inability to produce antibodies. Antibodies play a key role in defending against pathogens.
Though unusual, the presence of both COVID-19 and XLA in the patient gave the researchers rare insight into remdesivir's antiviral properties and its effectiveness in the treatment of COVID-19.
Overall, the patient's dramatic response to the drug indicates that it may be highly effective against COVID-19, even if only for some patients, said co-author Nicholas Matheson from the University of Cambridge School of Clinical Medicine in the U.K.
Remdesivir reduces virus levels, improves symptoms
There have been several studies supporting or questioning remdesivir's effectiveness. However, some of those studies conducted during the first wave of the pandemic might not be ideal for assessing remdesivir's antiviral properties, said Cambridge's James Thaventhiran, who also worked on the case.
To address that, the researchers studied the case of a patient aged 31 years who became ill with COVID-19. He also had XLA, a disorder that affects the immune system's ability to produce antibodies. Antibodies latch onto foreign invaders and substances, or antigens, in order to remove them from the body. Because the patient was unable to produce antibodies, his body couldn't heal itself, hence the persistent symptoms.
Over a period of more than two months, the patient was first treated with two drugs that were also studied for their effects against COVID-19: hydroxychloroquine and azithromycin.
When those drugs proved ineffective, the patient was given two separate courses of treatment with remdesivir. During the first course of treatment, the patient's virus levels fell and his symptoms greatly improved.
The patient was discharged but returned a week later after his virus levels rose and he started showing several symptoms again. The second course of treatment with remdesivir proved to be even more effective after he no longer tested positive for COVID-19.
During both courses of treatment with the drug, the patient's virus levels declined, suggesting that remdesivir helped prevent SARS-CoV-2 from spreading. The researchers believe this also proves that XLA was inhibiting the patient's immune system from fighting the virus.
Remdesivir as COVID-19 treatment
Early on in the pandemic, remdesivir was thought to be a promising therapeutic for COVID-19. It was initially developed for the treatment of Ebola, a rare and deadly disease that caused a large outbreak in Africa between 2014–2016. The drug's effectiveness against the Ebola virus led scientists to suppose that remdesivir might be able to fight SARS-CoV-2 as well.
However, the drug's effectiveness against COVID-19 has been the subject of much debate since a large clinical trial led by the World Health Organization (WHO) showed in October that the drug failed to improve survival rates among COVID-19 patients.
Experts from the WHO also advised against the use of the drug for COVID-19 patients after President Donald Trump used remdesivir and other drugs to fight COVID-19 in October. (Related: Trump physician says president has developed COVID-19 antibodies.)
The WHO cited a lack of studies on the drug's effectiveness against the disease as the primary reason for their recommendation. Because remdesivir is an expensive drug, treatment with it will also use more resources.
But as the latest study shows, remdesivir is a promising therapeutic for COVID-19. That being said, Matheson and his colleagues also mentioned that the use of remdesivir should be tailored to individuals or subgroups of patients with distinct clinical characteristics.
Read the latest updates on the coronavirus pandemic at Pandemic.news.
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