Remdesivir, one of the drugs Donald Trump took when he developed Covid-19, should not be used in hospitals because there is no evidence it works, the World Health Organization has advised.
The US president was an enthusiastic proponent of the drug, to the point where he boasted in July that he had bought up the world’s entire stock for Americans. The WHO’s guidelines committee, however, has said Covid patients may be better off without it.
The WHO issued what it calls a “living guideline”, which can be updated as evidence comes in, largely as a result of a Solidarity trial it led in several countries. Solidarity allocated patients randomly to several drugs including remdesivir and found that those who took it were no more likely to survive severe Covid than those who did not.
There are other issues with remdesivir. Made by the US company Gilead, is extremely expensive and has to be given intravenously. The guideline, published in the British Medical Journal, concluded that “most patients would not prefer intravenous treatment with remdesivir given the low certainty evidence. Any beneficial effects of remdesivir, if they do exist, are likely to be small and the possibility of important harm remains.”
There were high hopes earlier in the year for the antiviral drug, one of the few medicines the US regulatory body, the Food and Drug Administration, gave emergency authorisation to for use against Covid-19. Some other countries also recommend its use.
Peter Horby, a professor of emerging infectious diseases and global health in the Nuffield Department of Medicine at the University of Oxford, who runs the Recovery trial of Covid treatments, said the way remdesivir was being used in the pandemic needed to be rethought.
Solidarity, which analysed the outcomes from more than 7,000 adults admitted to hospital with Covid-19 in four randomised controlled trials, had found no evidence of a meaningful benefit, he said.
“Given this lack of evidence of any benefit on mortality, the risk of ending up on a ventilator or the time to clinical improvement, the World Health Organization have reasonably recommended against the use of remdesivir in patients hospitalised with Covid-19, whatever their disease severity.
“Remdesivir is an expensive drug that must be given intravenously for five to ten days, so this recommendation will save money and other healthcare resources. Remdesivir has been recommended in several Covid-19 treatment guidelines so this new analysis will necessitate a rethink about the place of remdesivir in Covid-19.”
Older and cheaper drugs have shown real benefits. The steroid dexamethasone has been shown to save one in eight lives among people seriously ill in hospital with Covid.
Trump also took dexamethasone, although he was not in the severely ill category and trials have shown it has little effect taken earlier in the disease. He also took an antibody cocktail from the company Regeneron, which is not generally available, although scientists think it holds promise.