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Delhi doctors unlikely to follow new WHO advice, say remdesivir works in moderate Covid cases

WHO Friday advised against use of remdesivir for Covid because there’s ‘no evidence’ it improves survival, but doctors say it works on moderately ill patients.

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New Delhi: The World Health Organization (WHO) Friday advised against the use of remdesivir on hospitalised Covid-19 patients, but doctors in Delhi continue to advocate the use of the drug.

The WHO made the recommendation “as there is currently no evidence that remdesivir improves survival and other outcomes in these patients”.

However, doctors ThePrint spoke to in Delhi said they have found improved outcomes after using remdesivir on moderately ill patients, and have stopped usage on severely ill patients when it showed no impact on improving their condition.

These doctors said since Covid-19 is a new disease without a proven cure so far, medical professionals are using all possible ways to treat patients, including the use of remdesivir.


Also read: Approved by US, rejected by WHO — science of remdesivir & why it has turned controversial


WHO’s advice

In a statement Friday, the WHO issued a “conditional recommendation against the use of remdesivir in hospitalised patients, regardless of disease severity, as there is currently no evidence that remdesivir improves survival and other outcomes in these patients”.

The recommendation has been made by an international guideline development group for the WHO, which includes 28 clinical care experts, four patient-partners and one ethicist.

The group reviewed data from the WHO’s Solidarity Trial, as well as three randomised controlled trials. “The evidence suggested no important effect on mortality, need for mechanical ventilation, time to clinical improvement, and other patient-important outcomes,” said the statement.

Remdesivir in India

In June, remdesivir, an antiviral developed by Gilead Sciences, became a part of the Covid-19 management protocol issued by the Union health ministry as an investigational therapy for moderate cases (those on oxygen), and continues to be used widely among patients.

The clinical management protocol for Covid-19 issued by the health ministry on 3 July said remdesivir should not be used if a patient displays signs of liver damage, has severe renal impairment, is pregnant or lactating, or less than 12 years old.

Earlier, ThePrint reported that concerns about the use of remdesivir grew after the central government started reviewing it in July. These concerns only grew deeper after the WHO released interim findings of the Solidarity Trial in October. The central government is currently reviewing its use.

The WHO Solidarity Study — meant to study the impact of four drugs on mortality from Covid-19 — said remdesivir and three other drugs “appeared to have little or no effect on hospitalised Covid-19 patients, as indicated by overall mortality, initiation of ventilation and duration of hospital stay”.

Gilead then released its own study on the use of the drug, saying in a statement: “The benefits of Veklury (brand name of remdesivir) have been demonstrated in three randomised, controlled clinical trials, including a randomised, double-blind, placebo-controlled clinical trial (ACTT-1) — the gold standard for evaluating the efficacy and safety of investigational drugs.”

It added: “The results from the National Institute for Allergy and Infectious Diseases (NIAID)’s ACTT-1 trial, which was conducted primarily in the United States and Europe, found that treatment with Veklury resulted in clinically meaningful improvements across multiple outcome assessments in hospitalised Covid-19 patients. These data were peer-reviewed and published in the New England Journal of Medicine and have supported Veklury’s inclusion in multiple treatment guidelines.”


Also read: Final results of US trial reveal remdesivir could shorten recovery time in Covid patients


Most doctors advocate usage

Even after the WHO statement, doctors are advocating remdesivir.

“We are continuing to use the drug on moderate patients as we have found it useful on moderate patients. We have seen weakness and body ache and general well-being has improved, and patients don’t deteriorate if this drug is administered early,” said Dr Suresh Kumar, medical director at the Delhi’s largest Covid facility, LNJP Hospital.

“We are using it for now as we are seeing results on moderate patients. If the government guidelines change and they ask us not to use it, we will stop,” he said.

Dr S. Chatterjee, internal medicine specialist at Indraprastha Apollo Hospital, added: “We are using remdesivir on moderate patients. In our experience, we have found that there is little or no effect on mortality on patients who are on ventilator support, for instance.

“But if you start remdesivir early for those patients who have comorbidities and persistent symptoms, we have found that their symptoms are managed better and patients also feel better.”

No uniformity

Some doctors and hospitals are even continuing to use remdesivir on severe patients.

“This is a new disease, and there’s a new study every day, and guidelines keep changing. There are studies against the use of plasma therapy as well, but we are still using it, and even the Delhi Health Minister (Satyendar Jain) was administered plasma,” said Dr S.P. Byotra, chairman, department of medicine at Sir Gangaram Hospital.

“We are still using remdesivir in moderate and severe cases, because we have to try everything to keep the patient alive. Eighty per cent Covid patients don’t face complications, but for the 10-15 per cent patients who see complications, develop pneumonia and are on life support, we try everything to help them,” Byotra said.

But there are also those doctors and hospitals who have already stopped using remdesivir due to its inefficacy in severe cases.

“Initially, we were using remdesivir on both moderate and severe cases. Then, we started using only in moderate cases. But then we found that the drug has no impact. So we have stopped the usage since the end of September,” said Dr B.L. Sherwal, medical director, Rajiv Gandhi Super Speciality Hospital.

“Instead, we have found that steroids can be used in both severe and moderate cases in different doses, depending on the severity of the case,” he added.


Also read: Remdesivir needs more testing in Covid Solidarity trial before being junked — ICMR-NARI chief


 

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