IMPORTANT FACTS ABOUT Remdesivir

There is considerable row and anxiety about the short-age of Remdesivir in the market. There are a lot of concerns about the outcome of patients who may not receive it. What happens to patients who do not get Remdesivir? Is it a magic bullet to cure Covid infection? There are many misconceptions about this drug.

What is Remdesivir?

This an antiviral intravenously administered medication used in the treatment of hospitalised patients of Covid-19. This is not recommended for mild cases. The duration of treatment is for 5 days and may be extended to 10 days in patients showing inadequate response in the first 5 days, though other drugs are also supplemented, like steroids, blood thinners and Tociluzimab.

When is it best effective?

It may be best effective in the first week of coronavirus infection. It may be less effective after 10 days of onset of symptoms. The serious symptoms of coronavirus infection are not directly due to the virus, but due to the individuals immune response to coronavirus infection. This is known as the cytokine hie release phenomenon. This includes severe breathing disorders, low blood pressure and occlusion in arteries and veins.

Can it be given along with Hydroxychloroquine?

It is suggested that this is not a recommended combination as there is a drug interaction and the efficacy of Remdesivir is reduced substantially.

How does it help patients?

The preliminary date from the Adaptive Covid-19 Treatment Trial (ACTT) showed that patients on Remdesivir recovered faster than similar patients who received a placebo. The median time to recovery was 10 days with Remdesivir as compared to a placebo which took 15 days. However, a stas-artistically significant difference was not reached for survival by day 15 or by 29 days. The WHO solidity and the phase 3 simple trial were conducted in different ways. The inference was that Remdesivir if given early is beneficial in Remdesivl ‘DA Appr mg Store terms of duration of hos. capitalisation, though the overall death rates are not influenced by the majority of individuals.

What happens to those who do not get Remdesivir?

There is no need to be in a panic state. Till then Favipiravir may be instituted. Those who continue with symptoms in spite of Favipiravir may or may not be benefited by Remdesivir. Though there is inadequate data on this aspect. Other supportive treatment in terms of oxygen, antibiotics to take care of secondary bacterial infection and steroids are indicated. Our personal experience with the use of Tociluzimab in more than 100 patients so far, has been satisfactory if used in the early phase based on interleukin 6 levels.
In view of the shortage of Remdesivir, can the treatment be reduced to 3 days? There is no adequate data on this. However, it may reduce the viral load in most of the patients. However, the present guidelines do not support this, though this may be considered by health authorities.

What did the studies from China indicate?

They did not find any difference in time to clinical improvement, 28-day mortality or rates of SAPS-COV-2 clearance between Remdesivir treated and placebo-treated individuals.
The final interpretation of World Health Organisation Solidarity Trial? Remdesivir did not decrease the hospital death rates when compared to the local standard of care. Administration of Remdesivir did not reduce the need for ventilatory support. Can Remdesivir be given to children and in pregnancy? There is limited data on this aspect. In children where indicated, it has been proved to be beneficial. There has been some data to suggest that it may be used in pregnancy and nursing mothers as well. The benefits of the drug may be viewed in context with the risks involved. In a pandemic, shortages of certain drugs are unavoidable. As far as Remdesivir is concerned, its unavailability should-n’t cause sudden panic. This drug may reduce your symptoms and duration of hospitalisation but has not been proved as a life-saving treatment.

Categories : COVID-19
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Dr Jay Deshmukh is Chief Physician and Director, Sunflower Hospital, Nagpur Honorary Physician to Honorable Governor of Maharashtra and PondicherryCentral. Dr Jay Deshmukh is an M.B.B.S., M.C.P.S., F.C.P.S., M.N.A.M.S., MD From Internal Medicine – Bombay and New Delhi.

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