Hope: Severely ill patients at Chicago hospital showed rapid recovery after receiving Gilead's experimental antiviral drug

Hope: Severely ill patients at Chicago hospital showed rapid recovery after receiving Gilead's experimental antiviral drug

The happiest I’ve been in six weeks was reading this story.

Investors read it too, with the Dow Futures market suddenly evincing joy as well.

My layman’s understanding is that remdesivir has always been the best hope among scientists for a “miracle drug” that might put a real dent in the death toll. Hydroxychloroquine gets all the press because Trump has seized on it for whatever reason, but the evidence of its efficacy so far is mixed. The French study that put the drug on the world’s radar screen as a potential silver bullet against coronavirus was later withdrawn by the journal that published it because of flawed methodology. Some small studies from China indicated that it may have benefits against COVID-19, but another Chinese study released this week pointed the other way: “The pill didn’t help patients clear the virus better than standard care and was much more likely to cause side effects, according to a study of 150 hospitalized patients…” A new French study also showed few benefits from the drug, with less than a two-percent difference in mortality rates among patients admitted to the ICU who received the drug and those admitted to the ICU who didn’t.

Part of the hope for hydroxychloroquine was due to the fact that it’s already on the shelf, available for off-label use. Remdesivir is still in the trial stage. But the FDA is watching it closely, knowing its potential, and Gilead is moving it along as quickly as possible, knowing how much demand there’ll be if trials confirm its efficacy. The company’s running a study right now involving 2,400 COVID-19 patients who are severely ill at 150 different clinical sites. Today’s big news comes from just one of those sites, a hospital at the University of Chicago. That’s the catch — the new data doesn’t reflect the outcome from the whole study, just one hospital’s experience. But that hospital is respected. And its head researcher sounds very encouraged by what she’s seen.

The University of Chicago Medicine recruited 125 people with Covid-19 into Gilead’s two Phase 3 clinical trials. Of those people, 113 had severe disease. All the patients have been treated with daily infusions of remdesivir.

“The best news is that most of our patients have already been discharged, which is great. We’ve only had two patients perish,” said Kathleen Mullane, the University of Chicago infectious disease specialist overseeing the remdesivir studies for the hospital…

“It’s always hard,” she said, because the severe trial doesn’t include a placebo group for comparison. “But certainly when we start [the] drug, we see fever curves falling,” she said. “Fever is now not a requirement for people to go on trial, we do see when patients do come in with high fevers, they do [reduce] quite quickly. We have seen people come off ventilators a day after starting therapy. So, in that realm, overall our patients have done very well.”

She added: “Most of our patients are severe and most of them are leaving at six days, so that tells us duration of therapy doesn’t have to be 10 days. We have very few that went out to 10 days, maybe three,” she said.

A 98 percent survival rate among “severely” ill patients sounds good to me. One patient who received remdesivir in the Chicago hospital told Stat he was admitted with a fever of 104 degrees and was struggling to breathe. They gave him oxygen and then started him on the drug on April 4. He claims his fever dropped almost immediately; after his second dose he was off oxygen. He was out of the hospital on April 7.

Is this a gamechanger? We’ll have a better sense soon: Apparently Gilead has the results from the first 400 patients who received the drug as part of its study and could release them at any moment. Unfortunately there was no control group, which will make it harder to say definitively that remdesivir is what’s leading patients to recover rather than standard treatment. But 98 percent is hard to argue with: A recent British study of patients with symptoms severe enough to require “critical care” found that only half survived.

A couple of days ago I wrote that the prospect of a pharmaceutical treatment coming along soon to change the trajectory of this epidemic is the single best reason not to follow Sweden’s “herd immunity” approach. An uncontrolled outbreak (or semi-controlled in their case) will accelerate deaths in the name of getting past the disease sooner. Flattening the curve and slowing it down buys time for scientists to come up with something that may end up averting many of those deaths. It’s still early in Sweden’s experiment, but … it’s not looking great right now:

Might want to start locking down for a few months, at least until Gilead has the full data on remdesivir. A lot of Scandinavian grandmas who might not need to die for the sake of the economy might end up being saved that way.

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