Doctors anticipate patient requests for experimental remdesivir before all the evidence comes in

Before Wednesday’s hopeful news about the experimental antiviral remdesivir broke, doctors treating patients hospitalized for Covid-19 were already hearing from a few families desperate to get the drug for their loved ones. Now they expect to hear more pleas in the days to come, even though the data are preliminary, results are not available for clinicians to evaluate, and the drug is not yet approved for emergency use.

“Obviously, anything positive with regard to treatment is encouraging,” said Todd Sarge, medical director of the surgical intensive care unit at Beth Israel Deaconess Medical Center in Boston. “What concerns me has been these things get very much hyped up in the news, and [patients’ families] will definitely be requesting it more often. And that can be a difficult conversation between families and our clinicians because for one, it’s still experimental, and two, it’s not widely available yet.”

Wednesday’s news came from a study led by the National Institute of Allergy and Infectious Diseases. In the double-blind, randomized controlled trial of 800 people, hospitalized Covid-19 patients who received the drug recovered in 11 days versus 15 days for patients who got a placebo. That design is considered the gold standard because no one knows who is or isn’t getting the drug, minimizing the chance of bias in judging outcomes.

Still, doctors on the frontlines are sounding notes of caution and asking questions while they lead trials themselves.

“It’s not a magic bullet. It’s not a drug that’s a quick answer to the epidemic, but it’s a step in the right direction,” said Otto Yang, a professor of medicine at the David Geffen School of Medicine at UCLA who is leading an NIAID remdesivir trial at the UCLA study site. “These were seriously ill patients. One question I have is will it work better in patients that are not so ill? Will it work as prevention? These are really key questions.” 

Constance Benson, professor of medicine at the University of California, San Diego, School of Medicine and co-leader of an NIAID clinical trial there, is expecting to hear from patients.

“It’s been picked up by the news media and it has quickly crawled across our desk with people asking questions,” she said. “I’m sure every physician who encounters patients will be asked about this, who can get it and how can they get it? We don’t really have answers for that yet.”

At Brigham and Women’s Hospital in Boston, patients aren’t clamoring for remdesivir, said Francisco Marty, an infectious disease physician who is leading a trial there. He points to language as a barrier slowing the spread of news accounts about the antiviral. 

“What has been particularly shocking to me, because I’ve been doing trials for the last 18 years, is how mostly minorities have been affected,” he said. The hospital’s patient population for research trials is typically 80% Caucasian and 20% minority, but that ratio has flipped. “I speak Spanish as my mother tongue. I’ve never done so many consents in Spanish before.”

Dan Culver, a pulmonologist and critical care physician at the Cleveland Clinic and director of its therapeutics assessment committee, compared Wednesday’s news to more prolonged interest in antimalaria drugs. 

“Because of all the wide variety of different information patients are getting, it’s become a bit of a cacophony of ideas,” he said, adding that he’s not been getting as many inquiries about remdesivir as hydroxychloroquine. “That got more touted on the political end of things.”

“After getting burned a little bit with some more data coming out suggesting that [hydroxychloroquine] is not very useful, I think people are slightly less inclined to jump at the starting gun,” he said. “There’s still interest from patients, don’t get me wrong. But there’s not that kind of rabid desire that there was before. I think people recognize the scientific process has a role to play here.”

Robert Finberg, chief of medicine at UMass Memorial Medical Center in Worcester, Mass., encourages patients to join trials of remdesivir. “That’s the way we find out whether things work,” he said. “I think we’ve been very rewarded by the outcomes. Now, obviously, some people are going to get better on their own. And that’s great, too.”

It’s families posing these questions, said Sarge, at Beth Israel Deaconess, when patients themselves are so sick they need ventilators to breathe. The families’ anxiety is magnified when hospital rules mean they can’t visit their loved ones, he suspects. As they grasp for answers, something like remdesivir may look promising.

One family told Sarge they’re getting calls from friends and family members urging them to ask about possible treatments they learned from the news.

“They need to do something,” he said. “Sometimes that ‘something’ ends up being repeating back the news around various experimental therapies that they then request.”

STAT contributor Usha Lee McFarling and STAT national technology correspondent Casey Ross contributed reporting.