Anti-viral remdesivir, Wall Street’s darling, may not even work against COVID-19

The Dow Jones surged more than 700 points Friday — sparked largely by what investors saw as a promising study on remdesivir, an anti-viral drug and possible COVID-19 treatment by Gilead Sciences. As it happens, Gilead’s stock jumped nearly 10 percent on Friday as well. 

But what is remdesivir, and is it worth the excitement? Is Gilead Sciences really holding the “light at the end of the tunnel”? 

First of all, remdesivir is an anti-viral drug, meaning it inhibits the reproduction of the virus in someone’s body. It was originally developed to treat Ebola. 

Luckily, here in San Francisco, we have some of the best scientists to explain this to us — and one of them did so on Thursday afternoon during one of UC San Francisco’s online grand rounds forums. 

Dr. Annie Luetkemeyer, an infectious disease professor at UCSF, explained that the drug is not yet approved but is in multiple clinical trials. She took viewers through an April 10 study published in the New England Journal of Medicine. That is not the study that excited investors on Friday (that one was done by the University of Chicago). But drawing firm conclusions from both had a similar problem: there was no control group for either, and it’s difficult to know if the drug helped the patients or if they improved on their own.

Luetkemeyer’s take on the study in the New England Journal basically boiled down to: It’s too soon to know, and we need more information. 

There’s “a lot of discussion about what did we learn from this case series,” she said, “and it depends on whether you’re a glass-half-full or a glass-half-empty” kind of person. 

The study focused on 53 patients suffering from severe COVID-19 symptoms. Thirty-four of them had ventilation support. They all had been given the drug roughly 12 days after showing symptoms, and this was done once a day for 10 days. 

After a median 18 days, 68 percent of all the patients “improved” and 47 percent were discharged from the hospital. And, of those who were intubated (30 of the 53), 57 percent were extubated. 

Eighteen percent (or six of the 34) who were ventilated died, and 1 patient who was not on ventilation died as well. 

“But again, in the absence of a control arm, what can we say about this?” Luetkemeyer said. “Did remdesivir do better than expected? [Or] Is this what you would have seen had they not received any medication at all?” 

The same was true with side effects — liver function abnormalities, rash, diarrhea, or kidney infection. Sixty percent of patients had an “adverse event” with these symptoms, and 23 percent had a “serious adverse event.” 

But, without a control group, she said it was difficult to tell if those were just the symptoms of COVID-19, which are similar.  

To put the New England Journal study into context, she noted that past studies of mortality rates among severe COVID-19 patients who have been admitted to the ICU ranged from 16 percent to 78 percent. 

“So for me, what this tells us, when I try to think about this remdesivir data, is 18 percent really good?” Luetkemeyer said. “Or is it just what you would expect?”  

She said it’s too soon to answer that question considering all the factors, especially the wide range of mortality — which is likely determined by how sick patients are, the level of care they’re getting, and how overwhelmed the ICU is. 

“So I think the moral of the story is that it’s good to see data but that we need to not over-interpret compassionate use” studies, she said. “I’m certainly happy to see it but we’re really looking forward to randomized control trial data coming forward soon.”

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