Is Remdesivir the cure-all for COVID-19?

While some news reports have suggested that remdesivir is a silver bullet for COVID, the truth is slightly more complicated.

Remdesivir was initially developed by Gilead Sciences in 2009 for treatment of other viruses. It interferes with viral RNA replication. At the outset of the worldwide pandemic it was identified as a potential treatment for COVID. The drug is given through an IV for five to ten days, so it is only intended for hospitalized patients. Early studies suggested a modest benefit. But there was no control group (placebo group) in these early studies, so they did not give definitive answers. 

Last month promising data from several randomized clinical trials on hospitalized patients were released. Randomized trials provide the gold-standard when it comes to seeing if new treatments work. In the largest clinical trial, conducted in 60 sites around the world, remdesivir shortened hospitalized patients’ recovery time by 4 days (on average 11 days to recovery for remdesivir patients vs. 15 days for patients who got placebo). However, there was no difference in patient mortality.  In contrast, a much smaller placebo-controlled randomized Chinese study in patients with severe disease showed that the drug did not improve recovery time or reduce mortality. Scientists suggest the lack of impact in this study was due to the small sample size (237 patients vs. 1063). Moreover, remdesivir was started later in patients’ disease courses - on average 10 days from symptom onset vs. 9 in the larger study.

Doctors also ran a study to see how long patients should get remdesivir. A press release by Gilead on this SIMPLE study reported that five days of treatment was just as good as a ten-day treatment in patients with severe COVID-19 .

So who benefits? The jury is still out. Based on the data we have now, it seems likely there is benefit to giving remdesivir early in disease to patients who are hospitalized with COVID, but not to those that are critically ill.  So, it’s a promising treatment, but far from a cure.

 

Last update: July 20, 2020 08:30 am ET

Science review: GSN, ERS