The effects of remdesivir on long-term symptoms in patients hospitalised for COVID-19: a pre-specified exploratory analysis

COVID-19, a virus we are all well aware of by now, has affected over 775.6 million people worldwide, and has caused the death of over 7 million people so far. Millions of those affected had to be admitted to the hospital either to regular wards for supportive care such as oxygen (moderate COVID), or to intensive care wards (severe COVID). At the beginning of the pandemic, there were no drug options available for people who needed lifesaving help. COVID was too new, and there were not any known drugs that would help people get better more quickly, or for those with severe COVID, to survive.
What we knew about COVID was that it was a disease that seemed to cause death through an inflammatory process that doctors called a "cytokine storm" (technical name: hypercytokinemia). Cytokines are signalling molecules that your body uses every day to signal tissues to swell up in reaction to injuries, and this is a totally normal and necessary part of your body's reaction to infections. However, in some cases of COVID infection, when COVID gets into the body it seems to cause an uncontrolled release of way too many cytokines (the cytokine storm) which then causes the death of the patient, usually via multiorgan failure or "ARDS" (acute respiratory distress syndrome). Because time was short, researchers set off in various directions to try to quickly find a way to make sure that more patients survived COVID. Our study looked at the use of remdesivir, an antiviral medicine, which we hoped would help people be released from the hospital more quickly. We were also interested in checking whether remdesivir was able to help more people recover with fewer cases of long-COVID, which is generally defined as having symptoms caused by COVID for longer than 3 months after your initial infection.
Our trial initially tested standard COVID care with remdesivir, hydroxychloroquine with standard COVID care, or standard COVID care alone. Early in the study, researchers discovered that hydroxychloroquine was not at all useful for the treatment of COVID, and that patients given this drug did not do any better than those who did not get the drug, so we stopped assigning people to that treatment. These patients were grouped together with patients who had not received any drugs since the treatments gave an equal outcome. While a meta-analysis of all trials assessing remdesivir showed a moderate effect on time to discharge from hospital, we could not see that remdesivir had a positive impact on long-term symptoms in the patients who had received remdesivir compared to those who did not.
But what happened with those patients after they were discharged? Did the remdesivir patients do better than the patients who received just "standard of care" treatment while in the hospital? Or did they perhaps experience fewer symptoms of long-COVID (also called Post-COVID Syndrome) than the patients who 'only' had the standard COVID care?
Unfortunately, our results showed that there were no major differences between the two patient groups' quality of life scores at 3 months post-discharge. This tells us that the drug is lunlikely to help people feel better in the long- or short-term, which means we must continue in our search to find a drug that will help patients recover. However, as with all medical research, a negative finding is not the end! There are still many options open for testing to find effective medicines for use with COVID infections. We are hopeful that in the future, a drug will be found that is able to help with both the initial infection and long-term symptoms.
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Communications Medicine
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