COVID-19: It’s Remdesivir, Stupid! Coronavirus’ New “Standard of Care,” Lessons From HIV’s AZT, and Oxford University’s Risky Bet on a SARS-COV-2 Vaccine this Fall.
Yesterday, National Institute of Allergy and Infectious Diseases Director Dr. Anthony Fauci announced that preliminary data from a highly powered (1090+ individuals) randomized placebo control trial (Adaptive Covirus Disease Treatment Trial, ACCT-1) of Gilead’s Remdesivir (RDV) sponsored by his agency with sites in several countries, showed an improvement of 31% (11 days vs. 15 days, p=0.001) on the primary end point of time to recovery (hospital discharge). He declared the drug the new standard of care for future combination therapies in the same way zidovudine (AZT) laid the foundation for treating AIDS. However, a smaller (237 patients) randomised, double-blind, placebo-controlled, multicentre trial at ten hospitals in Hubei, China of the same drug did not produce any statistically significant difference in time to clinical improvement. AZT is a nucleoside reverse transcriptase inhibitor (NRTI), while RDV is a nucleotide analogue that possibly delays chain-termination by viral RNA-dependent RNA polymerase (RdRp) in SARS-COV-2 (Covid-19). Remdesivir’s potency in laboratory experiments confirm a broad-spectrum direct-acting antiviral (DAA) that efficiently and selectivity incorporates the active triphosphate form of RDV (RDV-TP) into RNAs of SARS-CoV, MERS-CoV, and SARS-CoV-2. Oxford University’s SARS-CoV-2 vaccine candidate ChAdOx1 nCoV-19 is based on similarities to the MERS-CoV vaccine candidate ChAdOx1 MERS. Human safety trials and efficacy trials on monkeys (protected them against Covid-19 even with high dose exposure to SARS-COV-2) are very promising with ambitious timelines. Concurrent production of a million doses is already underway, betting on eventual success and approval this Fall, to establish mass production capability to meet impending demands.
Articles reviewed for this post:
