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SINGAPORE: Doctors in Singapore are using remdesivir, a medication originally created to combat Ebola, to treat patients with COVID-19 here as part of clinical trials.
Dr. Shawn Vasoo, clinical director of the National Center for Infectious Diseases (NCID), told CNA that “there are no proven therapies” for coronavirus, and that remdesivir is one of the drugs being tested here as a possible treatment. for patients with COVID-19.
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Remdesivir has been described by the World Health Organization as one of the most promising therapies against COVID-19, which also includes two anti-HIV drugs and anti-malaria drugs, chloroquine and hydroxychloroquine.
NCID is part of a working group announced by Health Minister Gan Kim Yong in March that looks at how reused drugs and new therapies can be used to treat the disease.
READ: Singapore scientists plan to start testing the COVID-19 vaccine this year
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These include antiviral medications, anti-inflammatory medications, humoral therapies such as convalescent plasma and biologics, and vaccines.
The group will then provide a critical evaluation of the proposed treatments and address any queries about treatment regimens or adverse reactions.
Patients who enrolled to participate in clinical trials will receive remdesivir or a placebo, if they are in the control group.
“Some of these trials may be industry sponsored, for example remdesivir, or carried out in conjunction with other national or international agencies,” said Dr. Vasoo.
“The task force reviews the available evidence as it emerges and makes therapy recommendations for COVID-19 in the form of therapeutic guidance.
“Because there are no proven therapies for COVID-19 yet, it is important that robust clinical trials be conducted.”
The remdesivir vials are capped at a Gilead Sciences facility in La Verne, California, USA. USA, March 18, 2020. (Photo: Gilead Sciences via Reuters)
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WHAT IS REMDESIVIR?
Remdesivir, manufactured by the pharmaceutical company Gilead, is a broad-spectrum experimental antiviral medication created to treat Ebola.
A major Ebola trial began in the Democratic Republic of the Congo about four years ago, but was halted last year when it did not increase survival rates as much as two monoclonal antibody drugs.
But in February of this year, the US National Institute of Allergy and Infectious Diseases. USA (NIAID) said it was dusting off remdesivir to investigate how it would react against SARS-CoV-2, the pathogen that causes COVID-19.
Dr. Anthony Fauci, who oversaw the study, told reporters at the White House last week that the data shows that remdisivir has a “clear, significant, and positive effect” on the recovery time of COVID-19 patients.
But a test of the drug in Wuhan, China, the epicenter of the pandemic, showed that there were no benefits in terms of recovery time or mortality.
“In this study of adult patients admitted to hospital for severe COVID-19, remdesivir was not associated with statistically significant clinical benefits,” reported The Lancet medical journal, which published the findings.
The study in Wuhan had to be suspended early and did not have enough participants as planned.
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Dr. Vasoo said: “We are still awaiting publication of the full results of the NIAID trial and more data on remdesivir, and also the results of the trial (of) other agents such as immunomodulatory (anti-inflammatory) drugs, such as tocilizumab.
“Meanwhile, the mainstay for COVID-19 patients is ICU support and ventilator for people with severe illness.”
MEDICATIONS FOR HIV, MALARIA USED AGAINST COVID-19
In February, the chief health scientist at the Ministry of Health, Professor Tan Chorh Chuan, said that the antiviral drugs retro lopinavir and ritonavir, which are most commonly used to treat HIV, were administered to “a small number” of patients infected with the coronavirus in Singapore.
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Doctors make individual treatment decisions in consultation with their patients, with the “best available evidence,” said Dr. Vasoo.
He added that there have been some “limited” clinical trials and experimental data on the use of lopinavir, ritonavir and hydroxychloroquine to treat patients with COVID-19.
A vial of the Ebola medication Remdesivir is pictured during a press conference at Eppendorf University Hospital (UKE) in Hamburg, Germany, on April 8, 2020, as the spread of COVID-19 continues. (Photo: Reuters / Ulrich Perrey)
“These have had limited off-label use, on a case-by-case basis, with careful discussion with patients or their families, weighing the risk-benefit ratio,” explained Dr. Vasoo.
While monitoring the results of such “unsolicited use,” it is not the same as a “well-run clinical trial,” said the NCID clinical director.
He cautioned that the published data on the three drugs has not shown a “clear benefit effect” or shown “conflicting data.”
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He noted that a Hubei trial using lopinavir and ritonavir in patients with severe COVID-19 infection had returned with “disappointing results.” The test began a few days after the virus was identified.
An editorial in the New England Journal of Medicine (NEJM), which published the findings, said “no benefit was seen at the primary end point of time for clinical improvement.”
The results showed “interesting results” for the secondary endpoints, as there were fewer deaths among the patients who received the two anti-HIV drugs, but this observation was “difficult to interpret” due to the small number (199) of patients in the test.
The trial found that the drugs “had no discernible effect” on virus clearance.
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Dr. Vasoo said the trial showed that both drugs did not appear to be effective in patients with severe or later stages of the disease.
“It is not so clear whether this will be the case in a study with a previous treatment or in combination with other antivirals, and the authors suggest that more studies are needed,” he added.
“Therefore, there appears to be a limited role, if any, for lopinavir-ritonavir; Certainly more data on their performance in the previous treatment and in combination with other antivirals (eg beta-interferon) would be welcome. “
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