Remdesivir has been shown to speed up recovery times for patients with COVID-19 in a major US-led trial, becoming the first drug with proven benefit against the disease. Now, considering the biphasic attitude of the disease which seems to act as a direct viral insult at the beginning and then like an autoimmune response similar to what is observed in Hemophagocytic lymphohistiocytosis, the anti-viral treatment should given before this might happen.
I wish to know the opnion of the scientific community on this hot topic.
The ACTT included hospitalized patients with advanced COVID-19 and lung involvement. From this point of view, guessing that this antiviral would be more effective if administered early in the course of the infection would be a simple speculation. A similar design trial but administering the drug before the outburst of the immune response would be needed to answer this hypothesis.
Hello Piergiorgio
I would wait to read the full work before making a final judgment. In fact, the data that have been disclosed do not seem exciting to me. The trial was correctly sized, yet the most important outcome - mortality - was not significant. It is necessary to understand whether the observed mean effect can be diversified, with a greater effect in patients with earlier disease compared with patients with advanced disease, even if all enrolled patients were in a quite advanced phase. Anyway, I believe that with remdesivir we are far from having “the cure” for the disease. After all, we need antivirals specifically designed for Sars-Cov-2. In fact, all the antivirals tested in this setting have a binding affinity for the virus that can never be optimal, since they are not specific for this virus. As a consequence their effect, if ever present, can only always be modest.
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