With the number of Covid-19 diseases in China skyrocketing, effective drug therapy would be particularly important now. Chinese scientists now claim that a form of the active substance remdesivir that is suitable for swallowing has shown no worse results than Paxlovid (Pfizer), known in the West, in treating high-risk patients.
Remdesivir, an inhibitor of the viral polymerase enzyme of SARS-CoV-2 and related coronaviruses, was one of the first drugs to treat Covid-19. However, its use so far has been limited to hospitals because it is only available as an infusion. The drugs Paxlovid (nirmatrelvir-ritonavir, a protease inhibitor) and molnupiravir, which can be taken by mouth, were available primarily to prevent severe progression of the disease.
Trials with remdesivir variant
In any case, a worldwide search has been undertaken for ways to develop active ingredient variants of remdesivir that are suitable for daily ingestion via swallowable dosage forms (capsules, tablets). The Chinese pharmaceutical company Junshi Biosciences (Shanghai) has done this. A few days ago (December 28; DOI: 10.1056/NEJMoa2208822), the internationally respected medical journal “New England Journal of Medicine” published a phase III efficacy study comparing Paxlovid treatment of high-risk patients with Covid-19 and the remdesivir variant (VV116).
A total of 384 study participants were randomized to receive oral VV116 (600 milligrams every 12 hours on day one, then 300 milligrams every 12 hours on days two through five) or Paxlovid (300 milligrams of nirmatrelvir and 100 milligrams of ritonavir each ) for five days every twelve hours for five days). Study participants had an average age of 53 years, 92% suffered from mild symptoms of Covid 19. Three-quarters of subjects were vaccinated against SARS-CoV-2. The main risk factors were age over 60 years (almost 38 percent), body mass index over 25 (almost 33 percent), smoking (12.5 percent) and diabetes (just over ten percent). .
The main evaluation criterion was the patient’s recovery time (no or almost no symptoms for two days). Both forms of treatment were almost the same here. In the group treated with the remdesivir variant, patients recovered after four days on average. Under Paxlovid treatment, this was the case after an average of five days.
The results of a phase III study usually form the basis for approval. However, the manufacturer has not requested this in the US or Europe”, wrote the German medical journal. The VV116 can therefore be used mainly in China and other countries where Paxlovid is not available. “According to the results of the study, should be an equal, if not even better, alternative,” said the German Medical Journal.
drug combination
Studies with a combination of the viral polymerase inhibitor remdesivir and protease inhibitors (nirmatrelvir-ritonavir) may also be interesting for the future. Whereas polymerase inhibitors block the conversion of viral RNA to DNA, protease inhibitors stop the virus from replicating at a different point in the replication cycle. They prevent the formation of proteins suitable for assembling new viral particles.
In highly effective AIDS therapy, the combination of such drugs with the two active ingredients has proven to be a breakthrough in the therapy of HIV infection since about 1995. It has already saved millions of lives.
the economy suffers
The massive wave of infections following the end of the zero corona policy had a significant impact on China’s economy in December. The Purchasing Managers’ Index (PMI) released by the Chinese business magazine “Caixin” fell on Tuesday from 49.4 to 49 points in the previous month. If the index is below 50 points, a drop in the economic activity of the companies that are part of the survey is assumed.
While lockdowns and the imponderables of the strict zero corona policy have been the main drivers of economic weakness in China in recent months, business has now been overwhelmed by the high number of infections.
After the current corona wave settles down, economists expect the second-largest economy to recover over the course of the year.
EU reaction
According to a newspaper report, the European Union (EU) is offering free vaccines to China to contain the corona wave. The initiative forms part of efforts by EU Health Commissioner Stella Kyriakides to find a European response to the impending wave of infections, reports the Financial Times, citing people familiar with the matter.
She turned to her Chinese colleagues to offer solidarity and support. “Among other things, through public health expertise and donations of EU-adapted vaccines.” (apa/af/ww/pat)