A remdesivir study was published yesterday. Remdesivir is an experimental drug (not FDA approved) from Gilead that was initially developed for possible treatment of Ebola. This is a technical article intended for physicians. The article appeared in the New England Journal of Medicine, which is one of the premier medical journals.
I'll only make a few comments.
1. By now we are all used to seeing Dr. Fauci on TV talking about the value of controlled studies. This is
NOT a controlled study. It is simply a case series and, because it is not controlled, cannot be considered firm proof of drug efficacy. For it to have been a controlled study, you would have needed a control group of similar patients (matched so far as possible according to things such as age, sex, pre-existing health, severity of disease, etc.) who did not receive the drug. Then, at the end of the study period, you would compare outcomes in the treated group versus the untreated group. But with people dying, that would have been very cold-blooded and difficult to justify ethically.
2. However, the authors are able to compare their results to other uncontrolled case series that have been published and, in general, the outcomes with remdesivir appear superior. This is not a wonder drug, however. There is still a 13% mortality rate, but this is a lower mortality rate than the studies they compare to. The authors also try to make the case that the patients in this series were more seriously ill than some of the other case series they compare to. If that is true, that makes the lower mortality rate more impressive.
3. The cohort of treated patients only included those with disease severe enough to meet specific criteria. So this study says nothing about treatment for milder forms of Covid-19. That is in contrast to hydroxychloroquine, which has been so widely discussed in the media. There is talk about whether hydroxychloroquine might be useful for prophylaxis (to prevent infection) or for milder cases of disease. Remdesivir is administered intravenously, so it is very unlikely to be an outpatient treatment. Hydroxychloroquine is a pill.
4. I find it very interesting that patients had to agree not to use other investigational drugs for Covid-19. Let's use HIV as an analogy, which is another viral infection, and I'll let Google tell you about HIV treatment:
Most people who are getting treated for HIV take 3 or more drugs. This is called combination therapy or "the cocktail." It also has a longer name: antiretroviral therapy (ART) or highly active antiretroviral therapy (HAART). Combination therapy is the most effective treatment for HIV. Apr 9, 2019
So this makes me wonder if doctors will move toward combination therapy for treatment of severe cases of Covid-19. This article doesn't speak to that.
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