The fight against coronavirus has been an uphill battle. Although we may be past the peak, hundreds are still dying every day, and often there is little doctors can do to save those hit by this mysterious disease.
Yet eagerly awaited results of a ground-breaking medical trial have brought fresh hope.
US researchers have published early data which suggests a drug, called remdesivir, could effectively treat people with Covid-19.
Some have branded it a ‘wonder-drug’ and say it is a game-changing sign of progress in the battle against the disease.
US researchers have published early data which suggests a drug, called remdesivir, pictured, could effectively treat people with Covid-19
Dr Anthony Fauci, head of the US National Institute of Allergy and Infectious Diseases, which ran the trial, said the findings ‘prove a drug can block this virus’.
While there have been other small studies exploring the potential benefit of the treatment, which is given to patients through a drip, this was the largest and most vigorous to date.
It involved more than 1,000 patients in 75 hospitals across the world – including 46 people in the UK – and the results are far more promising than those seen in any other potential treatment to date.
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The drug is already available in the UK on a compassionate basis for pregnant women and children severely ill with the disease, and has just been fast-tracked by US health chiefs for emergency use in their most critically ill patients. So what is it exactly – and should we all be celebrating?
Remdesivir attacks an enzyme a virus needs in order to replicate inside cells. Laboratory and animal studies have previously shown the drug to be effective against other coronaviruses such as SARS.
These viruses are similar in structure to SARS-CoV-2 – the one that causes Covid-19.
The drug was originally developed for use during the 2014 ebola outbreak in West Africa. When other treatments showed more promise for that disease, research was halted.
Yet for this coronavirus, it could prove far more effective. According to early trial results published last week, hospitalised Covid-19 patients given remdesivir for ten days saw their recovery time slashed by a third compared with a group of patients given a dummy treatment. In practice, this meant the average recovery time was cut from 15 days to 11.
The drug also seemed to boost survival. About eight per cent of the remdesivir group died, compared with almost 12 per cent of those in the placebo group.
It’s a small difference that could have occurred for other reasons, so scientists are not deeming it to be statistically significant. However, data is still being collected.
When it has been, it’s possible that the difference between the two groups could turn out to be greater, says Brian Angus, professor of infectious diseases at Oxford University, who is involved in the British trials. ‘It’s not significant so far, but it is close,’ he says.
Dr Stephen Griffin, a virologist at the University of Leeds School of Medicine, agrees the results are promising – especially given how sick the patients were beforehand.
‘These are encouraging results and show a significant difference in terms of recovery,’ he says.
‘By the time the drug was given, the virus was well established and so it has a lot of catching up to do. It’s being asked to do a very difficult job.’
The reduction in recovery time may seem small but, given the number of Covid-19 cases worldwide, this could have a huge impact as it means freeing up intensive care beds, ventilators and easing the burden on hospitals.
‘We have a lot of Covid-19 patients who stay in intensive care for quite a while, needing support such as extra oxygen,’ says Prof Angus. ‘So if you speed up recovery by five days, that could be very useful.’
It may also protect patients from long-term damage.
‘We don’t know this for sure yet, but it seems likely that if they recover faster, there may be less damage to their lungs,’ Dr Griffin says. ‘And if it also means they are discharged from intensive care three or four days sooner, that’s good for the NHS.’
While the trial involved patients in hospital who were given the drug intravenously, it may be even more effective if given earlier on – before the disease becomes severe.
Despite the hopeful results, some experts say we must practise ‘cautious optimism’. The results of a far smaller remdesivir trial in Wuhan, China, pictured, – where the outbreak first began – showed no significant difference in the recovery time or mortality of patients
‘We know from other viral illnesses, like flu, that treating them early with antiviral drugs can almost stop the infection dead,’ says Peter Openshaw, professor of experimental medicine at Imperial College London.
‘But if you wait until the virus is well established, they may reduce the time you have symptoms only by a few hours.
‘If you start treatment very early with drugs such as remdesivir, you are much more likely to have a greater effect.’
There’s also the potential to increase remdesivir’s potency by combining it with other treatments. ‘We know from lots of infections that you need a combination treatment to benefit,’ says Prof Angus.
‘The next trial being considered is giving people remdesivir and something else to temper their immune response.
‘Because there’s a suggestion that a lot of the damage that is done in this illness is because of the immune reaction to the virus, not just the virus itself.’
Despite the hopeful results, some experts say we must practise ‘cautious optimism’.
The results of a far smaller remdesivir trial in Wuhan, China – where the outbreak first began – showed no significant difference in the recovery time or mortality of patients.
And the full data from the international trial has not yet been published, which means we do not know how ill patients have to be to benefit from remdesivir– it is possible those who benefited most would have recovered anyway.
And there’s also the difficulty of obtaining the drug – currently there is a worldwide shortage.
But remdesivir at least offers hope. ‘This drug is not an immediate cure,’ cautions Prof Angus. ‘But it is a step in the right direction.’
Arthritis remedy may be a lifesaver
A drug used to treat painful, swollen joints caused by rheumatoid arthritis could potentially save the lives of some Covid-19 sufferers.
Tocilizumab dampens inflammation in severe arthritis caused by a protein that is pumped out when the immune system goes haywire – known as a cytokine storm.
In some severe Covid-19 cases, this same over-reaction by the immune system occurs when the virus has established itself in the lungs. It is this reaction that causes inflammation and blood clots, leading to organ failure and death, in many cases.
The process is thought to be responsible for many Covid-19 deaths. But a small French study involving 129 critically ill Covid-19 patients found those given the arthritis drug were less likely to die and less likely to need life support than a control group who received antibiotics. Larger trials are now under way in the US and France to investigate further and check for side effects.
Dr Stephen Griffin, virologist at the University of Leeds School of Medicine, says: ‘It would be used when Covid-19 patients have really gone downhill. It’s not really treating the virus – it’s dampening the immune system instead.
‘We need further research to show if this means it takes longer to actually get rid of the virus.’