Advertisement

Remdesivir for Outpatient Management: Time to Wait, Not to Act

      In their Commentary, Mardikar et al
      • Mardikar H
      • Mardikar M
      • Deshpande N
      • Deshpande M
      • Admane P.
      COVID-19 Second Wave in India - Wait or Act?.
      describe their case conducted within one hospital where only 15 moderate risk patients with oxygen saturation ≥ 94% required neither actual hospitalisation nor remdesivir. None of the guidelines across the globe recommend remdesivir for patients having saturation ≥ 94% who can stay at home. The Infectious Diseases Society of America (ISDA) guidelines recommended the use of remdesivir only for hospitalized patients with severe COVID-19 (which is defined as patients with SpO2 ≤ 94% on room air, or those who require supplemental oxygen). Here none of the criteria of hospitalization and oxygen saturation is fulfilled.
      The result was analysed among mild COVID sufferers without any control or randomization. They studied two biomarkers: C-reactive protein (CRP) and D-dimer, without any mention of mean or cut off value. Biomarker measurements were repeated on completion of therapy. Without any control arm, the authors concluded that all patients showed a very good response at the end of the therapy irrespective of age and comorbidities, which are common outcome of such patients.
      I was deployed as a member of the Team constituted by the Disaster Management Cell of the Government of India to the State, during the peak of the crisis, when there was an average shortage of 18,000 to 20,000 vials of remdesivir injections daily.

      Facing shortage of 20K Remdesivir injections: Maharashtra FDA minister | Mumbai news - Hindustan Times URL: https://www.hindustantimes.com/cities/mumbai-news/facing-shortage-of-20k-remdesivir-injections-maharashtra-fda-minister-101618862193409.html (accessed on 30th June 2021).

      It is astonishing how the authors could ethically divert these injections from hospitalized patient to home isolated patients.
      What message do we want to relay? To me it seems like unfair, unclear and misleading information and seems to be biased literature. Are we giving an opportunity for others to follow or cite? Our behavior and practice must adhere to an evidence-based approach either to treat patients or to conduct a randomized control trial to clear rather than create uncertainty. We must protect patient patients and strive to find better ways to protect our scientific efforts and gather real-world scientific evidences. It is time to wait and observe, not the time to jump the gun and act prematurely.

      References

        • Mardikar H
        • Mardikar M
        • Deshpande N
        • Deshpande M
        • Admane P.
        COVID-19 Second Wave in India - Wait or Act?.
        Am J Med. 2021 Jun 24; (S0002-9343(21)00368-5Epub ahead of printPMID: 34175293)https://doi.org/10.1016/j.amjmed.2021.06.002
      1. Remdesivir. https://www.idsociety.org/covid-19-real-time-learning-network/therapeutics-and-interventions/remdesivir/ (accessed on 30th June 2021).

      2. Facing shortage of 20K Remdesivir injections: Maharashtra FDA minister | Mumbai news - Hindustan Times URL: https://www.hindustantimes.com/cities/mumbai-news/facing-shortage-of-20k-remdesivir-injections-maharashtra-fda-minister-101618862193409.html (accessed on 30th June 2021).