Antiviral reduces COVID-19 hospitalizations by 87%

The only FDA-approved COVID-19 treatment works when given early.

The antiviral drug remdesivir, approved to treat hospitalized COVID-19 patients, can also prevent people from ending up in the hospital at all, if given early, according to a new randomized trial. 

The problem is that the drug still has to be given as an IV infusion, which is hard to do before people are already in the hospital. But the result means that it is possible for antivirals to stop the disease early — and effective treatments for newly diagnosed patients may be on the horizon.

Antiviral drugs: Antivirals generally don’t kill viruses outright — instead, they interfere with their ability to replicate and infect cells. This can make it easier for the immune system to then clear the infection.

In October 2020, the FDA approved Gilead Sciences’ antiviral drug remdesivir to treat hospitalized patients with COVID-19 — making it the first (and, so far, only) fully approved COVID-19 treatment.

“These latest data show remdesivir’s potential to help high-risk patients recover.”

Robert L. Gottlieb

The challenge: Antiviral drugs are most effective when given soon after an infection takes hold, when slowing down the virus will make the biggest difference. But by the time a COVID-19 patient requires hospitalization, their infection is already advanced.

However, remdesivir must be delivered intravenously in a healthcare setting, usually once daily for three to 10 days, so the trials used to secure FDA approval were all of people who were already hospitalized — we don’t know what sort of effect it might have if administered earlier.

Gilead’s trial: More accurately, we didn’t know, but Gilead has now announced the results of a remdesivir trial involving nearly 600 non-hospitalized but high-risk COVID-19 patients.

For this trial, half of the patients received three daily doses of remdesivir, while the other half received a placebo. According to Gilead, the antiviral reduced hospitalizations by 87% and medical visits by 81%, compared to the placebo group.

“These latest data show remdesivir’s potential to help high-risk patients recover before they get sicker and stay out of the hospital altogether,” principal investigator Robert L. Gottlieb said.

An oral COVID-19 antiviral drug would be far easier to administer.

The cold water: Gilead is submitting the data from the trial to the FDA, but even if the antiviral drug is approved for early treatment of high-risk COVID-19 patients, they’d still have to go to a hospital to receive treatment.

That means they’d have to have transportation to the hospital three days in a row and stay for the 30 to 120 minutes it takes to administer each dose. While in public, they could potentially spread the virus to people who aren’t sick.

A better COVID-19 treatment: More exciting than the fact that remdesivir appears effective earlier in an COVID-19 infection, then, might be the evidence that an antiviral does work against less severe cases.

There are already several oral COVID-19 antiviral drugs in development. If any of those prove as effective as Gilead’s intravenous drug, they’d be far easier to administer — patients could just pick up pills at a pharmacy, avoiding the needles and hassle of hospital visits.

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