McMaster team leads WHO study that recommends against COVID antiviral drug

thespec.com

The World Health Organization is recommending against the use of an antiviral drug touted by U.S. president Donald Trump following a global study led by a team of McMaster University researchers.

An analysis of data from several clinical trials found no evidence that remdesivir provided significant benefits for COVID patients with respect to mortality, hospitalization, or reduction of ventilator use.

The WHO is now recommending against the use of remdesivir, which can cost as much as $4,000 U.S. per patient for a 10-day cycle.

The study involved 60 researchers from around the world, including 11 from McMaster. The lead author of the WHO report is Dr. Bram Rochwerg, an intensive care physician at the Juravinski Hospital and a McMaster researcher.

“When you talk about new drug treatments that have risks associated with them that cost thousands and thousands of dollars, you certainly want to see a signal that it improves something patients care about,” said Rochwerg. “We didn’t see any evidence of benefit.

“Is it possible there are certain groups of patients that could benefit? We couldn’t identify any of those groups based on what we did but it’s certainly possible,” he added.

Rochwerg said the WHO panel would like to see the drug studied further with more clinical trials.

“Although we think the majority of people should not receive remdesivir, we think they should keep researching this,” said Rochwerg, who treats COVID patients in intensive care.

Remdesivir has been used primarily in Canada as part of clinical trials, Rochwerg said, but in the U.S. and parts of Europe “every single hospitalized patient is getting remdesivir right now so I think the implications are much, much wider in certain places.”

Drug treatments for viral diseases, such as COVID-19, have traditionally been difficult to develop because viruses can mutate quickly and frequently, making them a moving target.

Remdesivir was originally developed as a treatment for the Ebola virus but it didn’t prove particularly successful. It was then put forward as a possible treatment for COVID-19.

Trump began touting the benefits of remdesivir early in the pandemic and then was treated with the drug in October after he was infected with COVID-19.

Early evidence from clinical trials suggested remdesivir could shorten recovery times for severely-ill hospitalized patients.

But recent results revealed in October from a worldwide clinical trial sanctioned by the WHO involving more than 11,200 patients “represents some of the strongest evidence yet that remdesivir is unlikely to be the lifesaving drug for the masses that many have hoped for,” according to a report in the latest British Medical Journal.

“None of the randomized controlled trials published so far have shown that remdesivir saves significantly more lives than standard medical care,” the report adds.

The recommendation from the WHO on remdesivir is what’s known as a “living guideline,” which means it will be reviewed and revised as necessary when new evidence comes to light.

The WHO indicated it will soon be providing updates on hydroxychloroquine, an anti-malarial drug also touted by Trump, and a two-drug combination of lopinavir and ritonavir as possible COVID treatments.

With the WHO’s recommendation against remdesivir, “it doesn’t leave us much in terms of treatment options for COVID and it’s unsettling to some degree,” said Rochwerg.

“But there are also reasons for optimism in terms of the recent vaccine news,” he added.

The only widely-used COVID treatment now are corticosteroids but they are typically used to treat severely-ill COVID patients who are receiving oxygen.

Rochwerg said it was gratifying that he and his colleagues were able to play a leading role on a global stage.

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“It’s a testament to the university and the fact that McMaster is known worldwide as a leader in producing trustworthy guidelines and evidence-based medicine,” said Rochwerg.

“It was awe-inspiring to work with these people, to work with the World Health Organization — all in the hope of improving care for COVID patients worldwide,” he added.

“It was very enlightening.”


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