Remdesivir is ‘the best that we have right now’ for COVID-19
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In response to the FDA’s recent emergency use authorization of remdesivir for the treatment of COVID-19, the Infectious Disease Society of America and the HIV Medicine Association, or HIVMA, called for public transparency from the federal government about the drug’s distribution.
Although the antiviral is still an investigational drug, it has shown evidence in clinical trials of reducing the time to recovery in COVID-19 patients. According to an IDSA release, Gilead’s contribution of 1.5 million doses of the drug can provide 10 days of treatment for 140,000 patients.
The concerns about transparency noted by IDSA and HIVMA are shared by some experts, including Infectious Disease News Editorial Board Member Peter Chin-Hong, MD, professor of medicine and director of the transplant infectious disease program at the University of California, San Francisco.
“Many of us worry that the government has already not been transparent about distribution and that things get lost along the way,” he told Healio.
Chin-Hong noted that a deeper understanding of the virus’s transmission is imperative.
“We still need to understand whether or not treating someone with remdesivir will actually prevent them from transmitting it when they leave the hospital,” Chin-Hong said. “We think it may reduce transmission because it does drop viral load, but by how much? These are all questions we need answered.”
In a joint statement, the IDSA and the HIVMA emphasized the importance of distributing remdesivir based on case counts and hospitalization rates, as well as ensuring communities disproportionately affected by the virus — like black and Latinx communities — are given equal access to the drug. In a separate statement, IDSA praised the decision from HHS to allow state health departments to distribute limited supplies of remdesivir, calling the action a “welcome change of course.”
“Remaining allotments of the drug should be distributed quickly, as parts of the country prepare for a peak in infections within the coming weeks,” the statement noted. “Full and immediate transparency on allocations will be essential for reopening plans to be informed by available resources.”
“It's not a magic bullet, but it's the best that we have right now,” Chin-Hong said. “It is great to use a virus drug for a virus. I think, for patients who are not incredibly sick, it will probably provide a modest benefit and hopefully prevent progression. For the sickest patients, I think the next phase of studies would be looking at trying to add something else to it, like an anti-inflammatory drug.”
A panel of pediatric infectious disease physicians suggested that remdesivir be used as the preferred antiviral for children with severe illness last month. As the outbreak continues, Chin-Hong expects further data will help guide the drug’s implementation.
“Until we get a vaccine in 12 to 18 months, we will be seeing outbreaks in different cities at different times,” he said. “This is not the end of the story — it’s not SARS. It's something that's here now and is going to be here for some time.”
Chin-Hong also noted that balancing speed and quality control is essential when addressing drug approvals, particularly in a pandemic environment.
“In a fast-moving epidemic, you don't need to know all the data if there's a good signal for mortality benefit,” he said. “But I think it begs the question of equity — and you need science to really inform equity.” – by Eamon Dreisbach
Disclosure: Chin-Hong reports no relevant financial disclosures.
Editor’s Note: This article was updated on May 11, 2020 to reflect the decision from HHS to allow state health departments to distribute limited quantities of remdesivir.
Perspective
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Raghavendra Tirupathi, MD
About two dozen hospitals are believed to have been chosen to receive remdesivir, but it is unclear why some medical centers were chosen to receive an allotment, whereas others weren’t — with a lack of transparency about what the criteria used are and who is making those decisions. The drug is a very sought-after resource and physicians need to know which hospitals have access to the drug.
The need of the hour is a real-time clearinghouse or database with information accessible to all. I work in a rural community hospital and am currently treating patients with COVID-19 who are severely sick and intubated, some on the verge of death with desperate family members asking about remdesivir on a daily basis. What are we supposed to tell them? We need to ensure there is fair, equitable and transparent distribution of the drug.
I am worried about patients in my hospital and community. As a rural hospital, we are always last on the priority list for trials, novel diagnostics and therapeutics. I wonder: Are we ever going to get the drug?
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