DISCUSSION
COVID-19 illness
DISEASE PROGRESSION, DISEASE, DECAY, TROPICAL DISEASES
This comparative in vivo pharmacodynamic assessment shows that remdesivir accelerates viral clearance in early COVID-19, as would be expected from an effective antiviral drug. Continued uncertainty over the efficacy and value of different COVID-19 treatments has resulted in substantial variation in therapeutic guidelines and clinical practice across the world. From 20 November 2020 until 22 April 2022, the 8 successive versions of the WHO's “Therapeutics and COVID-19: Living Guideline” gave a conditional recommendation It has become increasingly clear that antivirals are more effective in early COVID-19, when viral burdens are highest, than in late-stage disease (i.e., in hospitalized patients requiring oxygen or ventilation) where viral burdens have declined, inflammatory processes dominate, and anti-inflammatory interventions are most effective [In early COVID-19 illness viral load decay from the nasopharynx and oropharynx is approximately log-linear, although there is substantial interindividual variation in rates of clearance and baseline viral loads. The approximate 40% average acceleration in viral clearance rate observed with remdesivir in this study is similar in magnitude to that observed in trials with the oral drug molnupiravir, although the assessment methodologies were different [This study has several limitations. The relationship between rate of viral clearance and therapeutic efficacy has not been well established, although across tested antiviral interventions there is a general direct relationship between acceleration of viral clearance and prevention of disease progression [Remdesivir continues to have a role in the treatment of COVID-19 for certain populations [Summary of Patient Characteristics Included in the 2 Modified Intention-to-Treat Populations (N = 131)Abbreviations: BP, Bangplee Hospital, Thailand; HTD, Hospital for Tropical Diseases, Thailand; SD, standard deviation; UFMG, Universidade Federal de Minas Gerais, Brazil; VJ, Vajira Hospital, Thailand.
