Protocol Evaluating the Efficacy of Remdesivir for Long COVID Following a Confirmed COVID-19 Infection. (ERASE-LC), 2023, Mark Faghy, University of Derby, UK

Moved posts from this thread

BBC Article
https://www.bbc.co.uk/news/uk-england-derbyshire-67081243

Antiviral treatment for 100 LC patients (2+ years) i think under Faghy. Comment by him and David Strain.
Faghy posted on TwitterX.

edited for spelling

 

https://clinicaltrials.gov/study/NCT05911906?cond=Long COVID&intr=Remdesivir&rank=2

Adding this link to LC trial on Remdesivir. At least 3 people have queried if intention or desire is to add on a MECFS trial and Mark Faghy has been brief but very affirmative. Also included a comment by Christoph Strock highlighting WeandMecfs interest in assistance.
Chia used Remdesivir?
Strain in charge but not sure how motivated he is for MECFS?

 

Merged thread

https://www.bbc.com/news/uk-england-derbyshire-67081243.amp

This was in the news yesterday.

Any thoughts??

 

"The University of Derby is leading the £1.2m study that involves about 100 people who have lived with the condition for more than two years".

"Patients eligible to take part in the trial will undergo a series of tests before and after they are given remdesivir, including exercise tolerability, to monitor any improvements".

I think waiting 2 years for pwLC is a good thing. I don't think monitoring symptoms such as PEM would be accurate if they tested sooner in the illness.

 

In my eyes it's good, I highly doubt the trial will yield any positive results (it's only an exploratory study), but unfortunately that is just the way it is. The disappointing part of the trial is that it isn’t placebo controlled, I don’t see a reason why one wouldn’t do that.

 

I see no good reason for a trial of this size not to be placebo controlled. I think making matched placebos can be expensive but in view of the total cost it is hard to seat being an impossibility.

With those outcome measures it looks a bit of a dead duck.

 

Regardless of trial design, is the rational behind the use of Remdesivir in long covid a valid one?

I think the antivirals studies for ME has produced no convincing results, but I don't know for sure

 

I doubt it. Persistent viral antigen may explain a subset of LC but probably a minority. There is some evidence [1, 2] to suggest this might be the case so anti-spike MAbs are worth trialling. Though one problem is trying to select who might benefit, as persistent antigen may be quite common if you look and is found in those without LC symptoms.

I don't think we've seen good evidence of replication-competent SARS-CoV-2 reservoirs, so inhibiting RNA polymerase seems unlikely to be useful.

(I'd be looking much more intently at the role of latent viruses and targeting those mechanisms.)

 

I can completely understand why many researchers are currently focusing more on going after a persistent SARS-COV-2 virus rather than something like EBV.

First of all there are actually mAbs for SARS-COV-2 as well as many different antivirals, with different mAbs and antivirals being in development. With that PET tagging the virus suddenly becomes an option as well. From a naive pharmaceutical perspective it should also be easier to deal with persistent COVID-19 rather than some Herpesvirus whose possible mechanisms we don’t understand.

There’s far more knowledge on the possible and tangible opportunities for the EBV connection in MS and yet no-one has any idea why 99% of the people have no problems after an EBV infection and what the relationship between EBV and MS could look like. So going down a similar EBV route that has been tried in ME/CFS, probably doesn’t seem too useful to most LC researchers. Companies like Atara Bio, probably will only start working or supplying their means to study EBV’s role in LC once there is more knowledge or biomarkers of the disease. Cooperation with pharmaceutical companies is close to impossible for Long-Covid researchers, cooperation with those that have an EBV related therapeutic is even harder.

Finally, for funding purposes it’s often a lot easier to apply for a grant that says “we’re doing something new based on a new virus and new evidence” rather than saying “we’ll be doing something that was sort of done before without substantially more evidence being present, but now we’ll do it properly”.

I expect to see more latent virus research either if there are more positive results in MS research, once the viral persistence research has yielded more answers, positive or negative, or if the current latent virus research in LC yields breakthrough results (which I’m very sceptical about given the lack of research). From what I can tell it’s not really “either or” but rather “let’s try the simpler and more tangible solution first”.

 

From TwitterX a timeline of what this team has been doing and people involved.
Posting for info and still feel a little dubious but can’t place it.

 

Exclusion Criteria
Recognized as a 'severe risk' of experiencing post-exertional malaise following engagement in physical tasks. Determined using the De Paul symptom questionnaire

Why would PEM be listed as an exclusion for this trial?

https://classic.clinicaltrials.gov/ct2/show/NCT05911906