Remdesivir for Severe COVID-19: Expert Guidance on Use in Clinical Practice

The World Health Organization (WHO) recently updated its Therapeutics and COVID-19: living guideline to include the conditional recommendation for the use of remdesivir (Veklury^®; Gilead Sciences) in patients with severe COVID-19 and the conditional recommendation against its use in those with critical COVID-19. Previously, the WHO conditionally recommended remdesivir for patients with non-severe COVID-19.

Patient Care Online sat down with Elizabeth Sapey, BSc, MBBS, PhD, professor of Acute and Respiratory Medicine at the Institute of Inflammation and Ageing at the University of Birmingham, to further discuss the WHO’s therapeutic guideline update. In the video below, Dr Sapey discusses how the guideline update may impact future use of remdesivir for the treatment of COVID-19 and how she uses it in her clinical practice.

Elizabeth Sapey, PhD, Director, Institute of Inflammation and Aging, Consultant in Respiratory Medicine and General Internal Medicine, Birmingham Acute Care Research Group, University of Birmingham

The following has been editing for clarity.

Patient Care: How will the guideline update impact future use of remdesivir for the treatment of COVID-19?

Dr Sapey: Well, I think it's important to remember where we are in terms of the COVID-19 pandemic. We would all like to pretend it has gone away now and that it was behind us, but COVID-19 continues to impact individuals and health care systems around the world. In my own area of practice in Birmingham, England, we're still seeing patients being admitted with severe COVID-19. Although deaths are nowhere near as common, thank heavens, we are seeing patients still dying of COVID-19. Vaccination has been a huge success. It's one of those global successes that the scientific community should be so excited and proud about. We know that that's impacted on and reduced COVID-19 mortality and hospitalization, but it hasn't prevented it. And the types of patients at risk of the worst outcomes of COVID-19 remain the same. So we know that the risk of developing severe COVID-19 increases with age and the number of comorbidities that you have. Studies now looking post-vaccination still show that patients with severe COVID-19, after their vaccinations, still usually have those significant risk factors. My take home message from that is vaccination is great, it's hugely important, we should be encouraging everybody to be fully vaccinated across the program. But don't be complacent, don't think that that is enough to protect patients. Studies have shown very clearly that those at highest risk of hospitalization and death, the earlier you treat them, the less the impact of the disease will have, the more likely you are to prevent that hospitalization, ventilation, and mortality. We also know that SARS-CoV-2 is a mutating virus, so we're seeing different variants of concern emerging. And we know that those variants impact recommended treatment options. Some of the monoclonal antibodies are less effective with some of the newer variants, and we're watching this space really carefully to work out which combinations would be the most effective. But generally, antivirals like remdesivir have remained effective. The way I use this in my clinical practice, and the way I'm teaching people to use it, is look at the individual in front of you, make an assessment of how at risk they are of progressing to severe COVID-19. I almost don't let vaccination affect that decision. I just think, "Oh, good" if they've had it, and if they are at risk of hospitalization, early treatment, for example with remdesivir, can have a significant impact on that disease progression and protect that patient from the worst manifestations of COVID-19.