There has been much excitement this week about Gilead’s antiviral drug remdesivir, which has been given ‘Emergency Use Approval’ by the FDA for the treatment of covid-19. Gilead is now in the process of donating 1.5 million doses for compassionate use across the US and worldwide. But the efficacy of remdesivir is far from proven. Early data from the ongoing US trial (ACTT) suggests that it speeds recovery from covid disease, but we don’t yet have data to suggest it actually reduces the risk of dying. Which is the outcome most of us are interested in. Nor we can’t read too much into its ‘Emergency Use Approval’. This simply means that the FDA are allowing it to be used as an experimental treatment outwith the setting of a clinical trial. Recall if you will the earlier excitement over the malaria drug hydroxychloroquine, which was similarly given ‘Emergency Use Approval’ by the FDA earlier this year. The available data from its subsequent use disappoints: an observational study published in this week’s New England Journal of Medicine shows no obvious beneficial effect from the use of hydroxychloroquine in covid disease, although more robust trials are ongoing.
It is way too soon to know if remdesivir can cure covid disease, never mind whether it will do so reliably. We must await the outcome of the ACTT trial to know if it is indeed the silver bullet the world is hoping for.
Perhaps the most noteworthy outcome to date of research into remdesivir for the treatment of covid-19 is the failure of the original Hubei Province-based trial to recruit enough patients to render the data statistically valid. The researchers had planned to enrol at least 325 patients with severe covid disease, but fell short of this number. They were unable to enrol the requisite number of severe cases because stringent public health measures in Wuhan brought the outbreak under control. Which is a great outcome for the study population, if a little disappointing at an academic level for the researchers.
The learning point here is that, whilst it is absolutely essential that researchers continue to search for treatments which prevent death and morbidity from covid disease, we must not lose sight of the fact that measures to limit the spread of and eliminate coronavirus remain our best hope of minimising covid-related deaths. And will remain our best hope for the foreseeable future. Which means that isolating cases, adhering to physical distancing, assiduous handwashing and avoiding the transfer of nasal and respiratory secretions between people remain of the utmost importance. It would be good for us to keep this in mind as we get excited about Scott Morrison’s ‘roadmap to re-opening Australia’ and being able to see our friends and family again.
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