What is remdesivir, a treatment in the United States against the coronavirus?

Remdesivir has just been authorized in the United States -

• The antiviral remdesivir can now be administered in the United States as part of the coronavirus, according to an announcement by the United States Medicines Agency on Thursday.

• While no effective treatment has been found for Covid-19, is remdesivir the long-awaited solution?

• Lists of studies on the subject, history of treatment and supposed contribution of the latter,

  20 Minutes

  takes stock.

On Thursday, the United States Medicines Agency (FDA) granted full authorization to the antiviral drug remdesivir for hospitalized coronavirus patients, confirming a conditional authorization granted in May.

As a result of this decision, in the United States, remdesivir can be given to adults and children over 12 years weighing at least 40 kg, in cases requiring hospitalization.

It can only be administered by injection in a hospital or in an equivalent environment.

At the same time, an emergency authorization was granted for children under 12 weighing at least 3.5 kg.

Europe for its part ordered 500,000 doses in early October.

It did not take more to hope to see in the middle of the second European wave a beginning of a solution to the insoluble problem that appears to be the Covid-19.

Far from this candor,

explains everything about remdesivir, and why you should not expect miracles from it (sorry).

What is remdesivir?

Remdesivir is an intravenous antiviral treatment, and as its definition explains, it works to prevent or decrease viral replication in infected cells.

It was not originally developed to treat Covid-19 and had previously been unsuccessfully tested to fight malaria.

From the start of the coronavirus epidemic, it interested scientists who saw a possible use in it.

The treatment is promising, especially in test tubes, where it shows real results, much better than those of the famous hydroxychloroquine for example, says infectious disease specialist Nathan Peiffer-Smadja.

Tests on monkeys with Covid pneumonia in the United States also show good effects.

It was then part of the treatments evaluated by two of the world's largest clinical trials on the coronavirus, namely Discovery (France and European Union) and Solidarity (led by the WHO).

The English clinical trial Recovery gives up testing it, “but more for technical reasons than out of mistrust of this treatment.

Simply, Recovery has difficulty in obtaining doses of remdesivir and considers that intravenous treatment is complex, the English prefer to evaluate things that are simpler and easier to access, ”says Nathan Peiffer-Smadja.

What do these studies say about the effects of remdesivir?

After a randomized trial on 1,000 patients, double blind and against placebo (patients in the trial ingest a placebo instead of the treatment tested), “a reduction in the length of hospitalization is observed.

Patients stay on average four days less in hospital than without treatment, ”says the infectious disease specialist.

On the other hand, and this is where the shoe pinches clearly, there is no impact on the mortality rate, which remains the same with or without remdesivir.

After this trial, Solidarity and Discovery continue to evaluate the treatment.

Solidarity publishes these preliminary results (including Discovery patients), which show no effect on 28-day mortality.

It is not that we want to lower your morale, but no treatment tested by Solidarity has shown an impact on the mortality of the virus.

Discovery's trial is ongoing, "and the results are eagerly awaited, as it focuses more on the virological effect and the impact on hospitalizations of the treatment," said Nathan Peiffer-Smadja.

Basically, the actions where remdesivir would have an effect, now that its zero efficacy on lethality is recognized.

In the United States, trials lead to similar conclusions: a significant clinical improvement in patients with no difference in mortality.

Is this going to change anything?

Clearly no, for Nathan Peiffer-Smadja.

“Remdesivir should not be seen as a

in the epidemic or as an effective treatment against the coronavirus,” the infectious disease

specialist

immediately warns.

Understand that by not modifying the death rate of the virus, it will logically not be able to change much in the waves of epidemics which are currently hitting the world: "Corticosteroids, for example, have demonstrated their impact on serious patients, this that remdesivir did not succeed ”.

There is therefore no need to expect the United States to get rid of the virus after the authorization of this treatment.

No impact on mortality, of course, but when we see the problems raised by the saturation of hospitals by Covid-19 patients - overcrowded places, proximity and contamination between patients, deprogramming of other diseases or choice between resuscitations - , could not four days of hospitalization gleaned for surviving patients already constitute a contribution in the fight against this pandemic?

Nathan Peiffer-Smadja: “This is indeed an argument in favor of remdesivir, although it asks to be confirmed.

It remains astonishing a decrease in hospitalization without any decrease in mortality.

"

In the end, it is indeed the skepticism which dominates on this treatment, even after the agreement of the American Agency.

"An intravenous treatment therefore complex, relatively expensive - we are talking about 2,000 dollars for five days of treatment, with extremely moderate effectiveness", supports the infectious disease specialist.

We warned you, this is far from being the miracle drug.

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