Explained: Is Remdesivir a life-saving drug; what alternatives are available?

Pic/AFP

At a time when the country is witnessing a massive surge in coronavirus cases and an insurmountable strain on the health infrastructure, anti-viral drug Remdesivir has become the most sought after drug to treat hospitalised coronavirus patients. In fact, the centre government has banned the export of Remdesivir from April 11 in order to fight its shortage. However, the Indian medical fraternity has been claiming that it is not a life-saving drug and its unnecessary use is unethical.

Mid-day online spoke to Dr. Bipin Jibhkate, Consultant critical care medicine, and ICU director, Wockhardt Hospital, Mumbai to understand the role of Remdesivir in the battle against coronavirus and if it is really a "magic bullet."

What is Remdesivir?

"Remdesivir was approved as the first drug to treat COVID-19 by the US Food and Drug Administration in 2020. When the entire world was struck by the COVID-19 pandemic, the drug was said to be useful in dealing with SARS-COV-2 and it was given authorization for emergency use. It is being used ever since and now that has led to a severe scarcity of the drug in the country. It is an anti-viral drug that is being used in the treatment of COVID-19 patients who come in severe and critical condition. It has to be administered early (between 6-12 days). This anti-viral drug was earlier manufactured in 2014 to fight the Ebola virus and the Middle East Respiratory Syndrome (MERS)."

Why is it important?
"Remdesivir is making headlines as it is thought to be a miracle drug. Its demand has gone up in the country amid the second wave of Coronavirus. This drug is given in a small subset (in terms of shortening the time to recovery by approximately five days) of patients when it comes to Coronavirus. Since it has been used indiscriminately in those infected with the virus, it has led to a scarcity of the drug."

How can it fight COVID-19?
"Remdesivir was used as we didn't have any anti-viral drugs. This drug was proven to be beneficial for those who required hospital admission and were on oxygen. This anti-viral drug can be opted by people who are admitted to the hospital. Remdesivir is injected intravenously and it tends to subsume itself into the genetic material of the virus by preventing the replicating enzyme from making new copies of the virus."

How effective is it?

"It is said to treat and relieve severely ill COVID-19 patients. But there is no clinical trial or evidence to support this claim. In India, the Ministry of Health has also recommended it as an investigational therapy in their COVID-19 management protocol document. However, it is not clarified whether it is a life-saving drug or a magical bullet. This drug is just used because we do not have any anti-viral drugs. This drug cannot be taken as a regular antibiotic."

Who can take Remdesivir?

"This drug is given to moderately or severely ill COVID-19 patients in the hospital and who are on oxygen. For administering the drug, one's liver and renal function tests have to be monitored first. It can't be given to those patients who have liver and renal failure. It cannot be given to those who are asymptomatic or have a low viral load."

Are there any side-effects?

"The listed side-effects of this drug can be an infusion reaction with symptoms like low blood pressure, nausea, allergic reactions, and vomiting. It can also lead to fatal allergic reactions in people."

Can it bring down the mortality rate?

"Based on available evidence, Remdesivir that is given to hospitalized patients didn't reduce mortality, it didn't cut down the duration of hospitalization and it didn't affect the progression of the disease. Remdesivir that is authorized for the treatment of coronavirus fails to prevent deaths among patients or reduce the hospital stay, revealed a large study named ‘Solidarity Therapeutics Trial', that is conducted by the World Health Organization (WHO)."

Is there an alternative of Remdesivir?

"Tocilizumab injection is widely used to treat critically ill patients infected with Coronavirus. This drug can be used when the patient goes into respiratory failure. This drug will help your respiratory system by blocking IL-6 receptors. A single dose of this drug should not exceed more than 800 mg. Favipiravir drug is used in the initial stages, that is, first 7-8 days and given to moderate to severely ill patients. If the patient has gout, he/she needs to be careful, and the patient will have to be monitored for liver function before giving it. Dexamethasone is a steroid for those with hypoxia (oxygenation problems). It is not to be used in the early phase as it can be dangerous for the patient. It has to be started after 10 days and used for the ones with respiratory failure. If it is used too late then also it will not be beneficial. It should be used with caution in patients with high sugar.

Hydroxychloroquine was also used for the treatment of COVID-19. But, there is no clinical evidence available about its efficacy."

How to source Remdesivir?

With every passing day, sourcing this anti-viral drug is becoming more difficult. However, leads can be gathered from the official websites of the producers of Remdesivir. Seven Indian companies; Mylan, Hetero, Jubilant Life Sciences, Cipla, Dr Reddy's, Zydus Cadila and Sun Pharma produce Remdesivir injections.

Besides, social media toolkits and helpline numbers have also proved to be helpful in this critical hour.

How much does it cost?

A vial of Remdesivir can range anywhere between Rs 899-Rs 3,000.

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