Dilemma for State over Remdesivir

WHO sceptical about efficacy of costly drug used to treat serious COVID patients

The State Medical Board is said to be in a fix over Remdesivir, the expensive antiviral and the much-hyped drug to have emerged during the pandemic as the efficacious treatment for serious COVID-19 patients, now that the WHO has issued a conditional recommendation against the use of Remdesivir in hospitalised patients, regardless of disease severity.

While the ICMR has not made any directives to remove Remdesivir from the treatment protocol of States, doctors are not quite sure whether they should continue to recommend a drug which does not offer significant mortality benefits, given the fact that the drug has been huge drain on all government medical college hospitals (MCH).

Remdesivir, which was the first drug to be touted as an efficient antiviral against COVID-19 in the US, has been included since July under the national treatment protocol for COVID-19, for “restricted emergency use purposes in moderate COVID-19 cases” under “investigational therapies”.

₹40,000 per patient

“A lot of patients improve without any drugs and hence we cannot really say if Remdesivir is a beneficial drug. The main concern is regarding the the cost of the drug, which is ₹40,000 per patient for a full five-day course. While it is taken to be the standard of care in the private sector, Remdesivir is being provided free of cost to all serious patients (requiring supplemental oxygen) and all government medical colleges in the State have now spent crores purchasing this drug,” a senior Health official said.

“Cell studies have shown that Remdesivir inhibits SARS-CoV-2 replication and reduces viral load . Even when the drug fares poorly when it comes to cost vs benefit, doctors are perturbed that they would be left with just steroids to fight COVID-19. The WHO report did not rule out the use of the drug altogether as a COVID-19 treatment, but said evidence was lacking to recommend its use. As trials are continuing, better evidence could emerge,” says R. Aravind, Head of Infectious Diseases, Thiruvananthapuram MCH.

It is not like the State has been following the WHO directives blindly. The State continues to swear by Hydroxychloroquine’s efficacy in the very early stage of the disease even though WHO found the drug to provide no incremental benefit to COVID patients.

Conclusion from 4 trials

It was last week that an expert panel of WHO, which reviewed evidence from four trials, including the National Institutes of Health (NIH) study (which led to the approval of the drug) and the WHO-sponsored Solidarity trial (a large international trial which involved over 5,000 patients in 405 hospitals in 30 countries), concluded that Remdesivir has no significant impact on mortality, length of hospital stay, or need for ventilation among hospitalised patients and that it is unlikely to be the life-saving drug it was made out to be.

While the State is not ready to be the first one to discontinue Remdesivir, the decision is likely to hinge on the drug’s cost factor and the question whether the State’s scarce resources could be better spent.

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