ABSTRACT
This post hoc analysis of the Adaptive Coronavirus Disease 2019 (COVID-19) Treatment Trial-1 (ACTT-1) shows a treatment effect of remdesivir (RDV) on progression to invasive mechanical ventilation (IMV) or death. Additionally, we create a risk profile that better predicts progression than baseline oxygen requirement alone. The highest risk group derives the greatest treatment effect from RDV.
Subject(s)
COVID-19 Drug Treatment , Adenosine Monophosphate/analogs & derivatives , Alanine/analogs & derivatives , Antiviral Agents/therapeutic use , Clinical Trials as Topic , Humans , Respiration, Artificial , SARS-CoV-2ABSTRACT
Coronavirus disease 2019 (COVID-19) outcomes are linked to host immune responses and may be affected by antiviral therapy. We investigated antibody and cytokine responses in ACTT-1 study participants enrolled at our center. We studied serum specimens from 19 hospitalized adults with COVID-19 randomized to treatment with remdesivir or placebo. We assessed severe acute respiratory syndrome coronavirus 2 antibody responses and identified cytokine signatures, using hierarchical clustering. We identified no clear immunologic trends attributable to remdesivir treatment. Seven participants were initially seronegative at study enrollment, and all 4 deaths occurred in this group with more recent symptom onset. We identified 3 dominant cytokine signatures, demonstrating different disease trajectories.
Subject(s)
COVID-19/immunology , COVID-19/mortality , Immunity/immunology , Adenosine Monophosphate/analogs & derivatives , Adenosine Monophosphate/immunology , Adenosine Monophosphate/therapeutic use , Adult , Alanine/analogs & derivatives , Alanine/immunology , Alanine/therapeutic use , Antibodies, Viral/immunology , Antiviral Agents/immunology , Antiviral Agents/therapeutic use , COVID-19/virology , Cytokines/immunology , Female , Humans , Immunity/drug effects , Male , SARS-CoV-2/drug effects , SARS-CoV-2/immunology , COVID-19 Drug TreatmentABSTRACT
Remdesivir is a nucleoside antiviral recently studied in several randomized trials for treatment of COVID-19. The available observational and prospective data are conflicting, requiring clinicians to critically evaluate and reconcile results to determine patient populations that may optimally benefit from remdesivir therapy, especially while drug supply is scarce. In this review, we analyze pertinent clinical remdesivir data for patients with COVID-19 from January 1, 2020, through May 31, 2020.