Optimizing Remdesivir Use for COVID-19

A look at the means by which clinicians are quantifying and evaluating the effects of the antiviral drug.

Last week, new data from Gilead-funded investigators showed no significant difference in clinical improvement between a five-day and 10-day course of remdesivir among patients hospitalized with coronavirus 2019 (COVID-19).

The 400-patient randomized trial assessing 2 differing doses of the much-discussed RNA polymerase inhibitor—published in The New England Journal of Medicine—showed limited differences in clinical improvement over 2 weeks among patients with confirmed, severe SARS-CoV-2 infection.

Based on a seven-point ordinal scale for clinical COVID-19 status in the hospital, the investigators observed that at 14 days, clinical improvement was more commonly reported in the five-day group (65%) than 10-day group (54%).

Abut after adjusting for baseline characteristic imbalance among the treatment arms, patients to receive 10-day remdesivir had a distribution in clinical status considered similar to that of five-day remdesivir patients (P = .14).

How do these findings influence clinical use of the antiviral drug? For one thing, it could help them assure minimal resources are not wasted in a pandemic.

In an interview with Contagion®, editor-in-chief Jason Gallagher, PharmD, Clinical Professor at Temple University College of Pharmacy, discussed how the newest findings’ utility serve not in understanding remdesivir efficacy—but in its optimal time and duration of use in hospitalized patients.

And though those findings are minimal in their impact—relative to other ongoing clinical trials for COVID-19 candidate therapies—they do continue to help shape absolute understanding of the virus burdening patients at a global scale.

“I’ll be quite honest: when I first saw that it was being done, I didn’t know what the point was,” Gallagher said. “But now that it’s out there, I’m kind of glad—because since we have this drug in such a limited supply, seeing there was no apparent benefit to extending the course of therapy to 10 days versus a shorter course will at least let us conserve drug.”