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Physicians around the world are repurposing old drugs as potential therapies for critically ill patients with COVID-19, including the HIV combination therapy lopinavir-ritonavir and the antimalarial chloroquine. WHO announced this week that it will test some of these treatments in an international trial, and other studies are underway or have been announced. Results of a study published this week showed no benefit from lopinavir-ritonavir in hospitalized adults with severe COVID-19.
Remdesivir (Gilead Science), an investigational antiviral developed as a potential therapy for Ebola, will be included in the WHO study and is already being tested against COVID-19 in five clinical trials. The first began last month at the University of Nebraska. Infectious Disease News Editorial Board Member Peter Chin-Hong, MD, professor of medicine and director of the transplant infectious disease program at the University of California, San Francisco (UCSF), has managed patients with COVID-19, including some who are critically ill, and has requested remdesivir for compassionate use. He said UCSF is now part of one of the trials. We spoke with Chin-Hong about his experience managing patients with COVID-19 and requesting remdesivir, and the fears facing members of the medical community who are on the front lines of this pandemic
Q: Do you have advice for physicians who would like to request remdesivir? You need to work with a pharmacist. Pharmacists are your friends. And you need to do some prework before you even see your first sick patient so when the time comes, you don’t have to scramble to get everything done. Prework might include calling the institutional review board locally to tell them what the situation is so they are prepared, having pharmacists build order sets in electronic medical records, getting the investigational pharmacists up to speed, and identifying who will give consent to use the drug if a critically ill patient is unable to do so. The adage is, “Any consent is better than nothing.” But if you can’t find anyone, you can write that on the chart and will still be able to give them the drug.
