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The following is a summary of “SARS-CoV-2 RNA and nucleocapsid antigen are blood biomarkers associated with severe disease outcomes that improve in response to remdesivir,” published in the April 2024 issue of Infectious Disease by Singh et al.
Researchers conducted a retrospective analysis of the ACTT-1 trial investigating the correlation between reductions in SARS-CoV-2 RNA and antigen levels in blood with clinical benefit from remdesivir treatment.
They evaluated longitudinal specimens collected during hospitalization from a subset of 642 patients with COVID-19. The specimens were measured for viral RNA (from the upper respiratory tract and plasma), viral nucleocapsid antigen (from serum), and host immunologic markers. Clinical outcomes and response to therapy were assessed by these measurements.
The results showed higher baseline plasma viral loads were associated with poorer clinical outcomes and decreases in viral RNA and antigen in blood, but not the upper respiratory tract, which correlated with enhanced benefit from remdesivir. The treatment effect of remdesivir was most pronounced in patients with elevated baseline nucleocapsid antigen levels: the recovery rate ratio was 1.95 (95%CI 1.40-2.71) for levels >245 picograms per milliliter (pg/ml) vs 1.04 (95%CI 0.76-1.42) for levels < 245 pg/ml. Remdesivir also accelerated the rate of viral RNA and antigen clearance in blood, and patients whose blood levels decreased were more likely to recover and survive.
Investigators concluded that lower blood levels of SARS-CoV-2 RNA and antigen measured during treatment were associated with improved patient outcomes from antiviral therapy.
Source: academic.oup.com/jid/advance-article/doi/10.1093/infdis/jiae198/7657712