An Open-Label Feasibility Study of Remdesivir in Long COVID: Results from the ERASE LC Trial

Objective

Treatment of acute COVID-19 with anti-viral and immunomodulator medications demonstrates a reduced risk of long-term outcomes. To date, remdesivir, an intravenous (IV) antiviral that prevents RNA transcription, has not been evaluated in people with Long COVID (LC). This study assessed the feasibility of a five-day IV remdesivir intervention for individuals with LC.

Methods

Seventy-three participants aged ≥18 years with a confirmed LC diagnosis were recruited across two sites in the United Kingdom to receive a five-day course of IV remdesivir. Primary feasibility outcomes included recruitment, treatment completion, acceptability, and safety. Exploratory patient-reported (e.g. Fatigue Assessment Scale [FAS]) and clinical outcomes (e.g. 6-minute walk test [6MWT]) were also collected.

Results

Of 106 individuals screened, 73 were enrolled and 71 (97%) completed the 5-day IV remdesivir regimen. Follow-up assessments were completed by 70 participants (96%), with high completion rates observed across clinical assessments, patient-reported outcomes and symptom tracking. No severe adverse reactions were reported. Improvements were also observed in several exploratory patient-reported and clinical outcomes.

Conclusion

We demonstrated the feasibility and acceptability of administering IV remdesivir in people with LC. Analysis of secondary outcomes suggests therapeutic promise, but rigorous evaluation in large-scale randomised controlled trials is essential to determine the true efficacy and clinical utility of intravenous remdesivir in this population.

Lay Summary

Long COVID (LC) can cause ongoing symptoms like fatigue and reduced physical ability after a COVID-19 infection. Some medicines used during acute COVID-19 infections, such as antivirals, may lower the risk of long-term problems, but it isn’t clear whether they can help people who already have Long COVID.

This study looked at whether it is practical and safe to give remdesivir (an antiviral drug given through a drip in the arm) to people with Long COVID over five days.

A total of 73 adults with Long COVID took part across two sites in the UK. Almost all participants (97%) were able to complete the full treatment. About one-third experienced side effects, but none were serious. Researchers also saw signs of improvement in symptoms like fatigue and in physical performance tests, although these were not the main focus of the study.

Overall, the study shows that giving remdesivir to people with Long COVID is feasible and generally well tolerated. While early results suggest it might help, larger and more rigorous studies are needed to find out if it truly works.