Many doctors who have been treating COVID-19 patients in India say that remdesivir is no magic bullet but it may still have its uses. The World Health Organisation has recently been advising against the use of remdesivir, which is listed as experimental therapy for COVID-19 by the Health Ministry.
The doctors said that to read the WHO recommendation as a strict do or do-not-do might be a “misinterpretation of the evidence”.
Neeraj Nischal, associate professor in the Department of Medicine, All India Institute of Medical Sciences (AIIMS), said, “The final decision (to use or avoid the drug) should be done after discussion with the patient. They should be given facts about the relative lack of benefit of the drug on the ultimate survival.”
Dr. Nischal noted that remdesivir, which was initially developed for use in the treatment of ebola and hepatitis C was found to be a promising candidate for COVID-19 through in vitro studies. “There has been a lot of hype regarding remdesivir since the start of pandemic. It was hyped so much that it was seen as a magic bullet by the general public. The medical community, however, was reserved in judging its effect and utility barring any evidence for its use. However, the drug eventually became the drug of choice for COVID-19 treatment, not due to its efficacy, but mainly through its popularity. This frenzy put social pressure on doctors for its use in even mild disease. This has led to indiscriminate use of this drug,” he said.
The doctor warned that there are many logistic and efficacy issues with remdesivir.
“It is an expensive drug requiring IV administration, and the timing and duration of therapy are still fairly unknown. The side effect profile of the drug has also been largely unknown and there are chances that some of its side effects may have been wrongly attributed to COVID-19,” he said.
The Health Ministry on its part has been advising against the wide and indiscriminate use of experimental therapies such as remdesivir and plasma therapy.
Rajesh Malhotra, head, Trauma Centre, AIIMS, notes that there are several reasons why hospitals are still using the drug. “Certain trials have shown that remdesivir reduces the time needed for recovery and they showed improvement in patients needing low flow oxygen. We are using remdesivir in early stages of the disease and have had good results with minimum side effects. But we cannot attribute it to remdesivir alone, as all these patients are candidates for and received steroids as well. Even we believe that it may not be of much use once disease has advanced in severity,” he said.
A.S. Soin, chief hepatobiliary and liver transplant surgeon of Medanta, said “This is no silver bullet and yes it is widely used. But we cannot blindly take in or give up any drug or therapy right now in a dynamic situation like this unfolding pandemic.”
Meanwhile, the Health Ministry on Saturday said that India has conducted 10,66,022 COVID-19 tests in the last 24 hours, which has increased India’s total cumulative tests to 13,06,57,808.
Also in the last 24 hours, 46,232 persons were found to be infected with COVID-19 while 49,715 new recoveries were registered during the same period. Maharashtra, Delhi and West Bengal have registered the maximum number of fatalities in 24 hours.