COVID-19: Putting The Latest Clinical Trial Data Using The Antiviral Drug Remdesivir Into Perspective.

ProperlyControlledTrials
MatterVille


Yesterday, we noted Anthony Fauci's comment on the limited early release of summary data from a multicenter, placebo-controlled clinical trial using the antiviral drug remdesivir in  COVID-19-confirmed patients with lung symptoms.

Essentially, Fauci touted the modest, yet statistically significant, improvement in 'time to recover' as well as the modest, yet not statistically significant (at least in conventional terms), mortality improvement as being important because these findings will now open the door to further improvements using subsequent combination treatment regimens.

You can listen to Dr. Fauci's comments (which he buttresses with the fact that the first efficacious antiviral drug against HIV-induced AIDS, AZT,  also only had modest effects on its own), here.

Of course, this has led to all kinds of speculation about how important the latest remdesivir findings actually are.

Derek Lowe, who has proven to be an honest broker in such matters, puts these and the other less impressive clinical trial data, including those published in the Lancet yesterday, in perspective:

...(T)he picture that’s emerging is that remdesivir may be of some help in less-severe cases. It is not a cure; a cure would have shown up in the trials we’ve run already, and cures are mighty thin on the ground for viral diseases. We can hope that the time-to-recovery is actually a useful measure and that the drug might get people out of hospitals a bit earlier, and hope a bit harder that there really is a mortality difference that will turn out to be real as we go into larger and larger numbers of patients. But working against that is the possibility that wider use of the drug will obscure the effect rather than make it more obvious...

Helpfully,  Dr. Lowe also gives his thoughts on remdesivir vs. the hydroxychloroquine:

...To forestall some questions that I know will come up: what do I think about this versus hydroxychloroquine? Well, we have more controlled data to work with on remdesivir, for one thing, so whatever benefits there are, are more obvious. The balance of what controlled data we have on HCQ is negative, and here we’re at least more mixed. There is also (to the best of my knowledge) no particular safety signal for remdesivir, as opposed to HCQ (particularly the HCQ/azithromycin combination). So while I’m not bowled over, I’m more optimistic than I am about hydroxychloroquine...


As for the combination therapy breakthroughs that Fauci is hoping for down the road? Well, here Lowe is more pessimistic. They seem to have different views on the applicability of targeted monoclonal antibody-based drugs.


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Lowe notes a weird quirk in the data in the Lancet paper, which is that remdesivir treatment did cause a noticeable decrease in viral load in that trial (which was carried out in China)...Given that remdesivir is designed to work by blocking the ability of the virus to make more of itself, if it really and trulyresults in a clinical improvement without decreasing viral load one would, as Lowe points out, 'have to wonder what's going on.'
For those of you new around these here parts, I previously wrote about Dr. Lowe's bonafides, both from an online communication and scientific perspective...Here.
Please note: while I am in the science geek game on the biology side of the ledger, I am not a virologist or drug developer, at least not in the strictest sense....That is why I am relying on honest brokers like Dr. Lowe in this case.

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