Dutch hospitals may have to do without a virus inhibitor remdesivir for a while. How bad is that?
With a new delivery, the national stock of the virus inhibitor remdesivir, which is managed by the RIVM, was replenished for a few days on Tuesday. The drug, which is used for patients with serious corona complaints, ran out on Sunday. The European Commission has pending a request with pharmaceutical company Gilead for new deliveries, so that shortages would be over next month. But until then it cannot be ruled out that hospitals will have to do without it for a while. How bad is that?
“It is very annoying that the drug is not available for a while, but it is not a national disaster,” says lung specialist Leon van den Toorn of Erasmus MC, also chairman of the Dutch association of pulmonologists NVALT. “It is a drug that can slightly improve the clinical picture of the corona patient. It can shorten the length of hospital stay. Patients recover just a little faster. ”
It is mainly given to patients who need oxygen in the regular ward of the hospital. It is not prescribed for patients with mild complaints or the most serious patients in the ICU.
Not a game changer
“It is certainly not a panacea,” confirms Peter de Jager, intensive care physician at the Jeroen Bosch Hospital in Den Bosch. He himself has doubts about the importance and effect of remdesivir. The virus inhibitor is often prescribed in combination with dexamethasone, an anti-inflammatory drug that has been around for decades. De Jager would find it much worse if that resource were no longer available. “If we had run out of dexamethasone, the consequences would have been much greater than with remdesivir,” said De Jager.
Studies show that patients who receive dexamethasone spend shorter periods in hospital and require less frequent treatment in the ICU. Scientific evidence for the effect of remdesivir is less clear-cut. “We know that dexamethasone works, but we don’t know exactly what remdesivir does,” said pulmonologist Van den Toorn. “There is clear scientific evidence for the effect of dexamethasone, for remdesivir that evidence is less clear.”
According to IC doctor De Jager, remdesivir is “not a game changer”. It is also included in the treatment plan for corona patients in the regular hospital ward. “But if it is not there, then we cannot prescribe it,” says De Jager. “There is also no substitute medicine available. Annoying, but not a disaster. ”
Pulmonologist Van den Toorn: “We have to wait a while without remdesivir and hope that the medicine can be delivered again soon. Of course it is better if we cannot give the drug to our patients for two days than for three weeks. But the Dutch population should not think now: oh dear, it is going all wrong. ”
Hepatitis C
In June, remdesivir was presented as the first anti-corona drug. The drug, which inhibits the production of new virus particles in the body, was approved by the European Medicines Agency EMA at the end of June. “This first corona drug is of course very good news,” Ton de Boer, chairman of the Medicines Evaluation Board (MEB) wrote in a column at the time. But he also warned that it is “not a panacea.”
Remdesivir was actually developed against hepatitis C. The virus inhibitor was later used against Ebola, but the drug turned out not to work against that disease. In corona patients, remdesivir is mainly used in combination with anti-inflammatory dexamethasone, whereby more value is attributed to the effect of the latter.
According to Van den Toorn, with the current combination treatment, only one in five admitted corona patients ends up in intensive care. During the first wave, that was about half. “We have a strong impression that dexamethasone in combination with remdesivir has a favorable effect on the course of the disease,” said the chairman of the association of pulmonologists. “We estimate that as a result 30 to 40 percent fewer patients need to go to the ICU.”
He notes that nowadays blood thinners are also given to every admitted covid patient and that the possibilities for giving large amounts of oxygen through the nose have increased. “These changes may also have contributed to the improved prospects for covid patients,” said Van den Toorn.
