Remdesivir for Outpatients, At Last

An article in last Sunday’s New York Times described the 7-hour search of a Times reporter who lives in Washington state for Paxlovid, the new Pfizer drug for oral treatment of COVID-19. Her elderly mother with risk factors living in northern California had just developed early symptoms of the disease and a positive at-home coronavirus test. Amazingly, with help from a Times colleague and a federal database of pharmacy chains that have placed orders for Paxlovid, the reporter found a pharmacy that had a supply of the drug, a doctor who would write a prescription, and an Uber driver who agreed to drive 120 miles round-trip to fetch it. Her mother took the pills within 8 hours of testing positive. I was surprised that any retail pharmacy had Paxlovid in stock, and after the story was published in the Times, which has a national circulation, I suspect that will be a one-off.

That is what we need, though, isn’t it? A drug we can take as soon as we recognize the symptoms and get our hands on an at-home test, which supposedly isn’t going to be so difficult anymore. We have 2 oral antivirals now, Merck’s molnupiravir in addition to Paxlovid, but both may be in short supply for some time. We have one monoclonal antibody (sotrovimab) that is active against the Omicron variant, but that also has been hard to find. Which leaves us with a long-neglected third antiviral: remdesivir, an inhibitor of SARS-CoV-2 RNA-dependent RNA polymerase that must be administered intravenously.

The first FDA approval of remdesivir was limited to hospitalized patients, virtually assuring that a drug that works by inhibiting viral replication won’t get into most patients before viral replication is over (8 or 9 days after the onset of symptoms) or close to it. President Trump and Governor Christie were hospitalized and treated with remdesivir relatively early in the course of their disease and of course they did well, but many other hospitalized patients were not so fortunate. Now, at last, a placebo-controlled randomized trial in high-risk outpatients, treated with remdesivir within 7 days after the onset of symptoms (still a little late), has demonstrated the drug’s value and the proper indication for its use.

An article on this subject is available on our website.

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  1. Allison Liddell says:

    The issue is convincing infusion centers to give it when reimbursement is questionable. Medicare has issued billing codes for it, so we are closer. Also, many outpatient infusion centers can’t accommodate infectious COVID patients and aren’t willing to risk exposing their high-risk chemo patients. A perfect place to give this is state-owned infusion centers which have been giving the monoclonal antibody. So far in my state, they haven’t stepped up.

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