The recent guideline on remdesivir issued by the World Health Organization (WHO), which has advised against the use of the COVID-19 drug to treat hospitalized patients, is still subject to review, according to head of the COVID-19 Task Force at the Georgetown Public Hospital Dr. Mahendra Carpen.
In a recent interview with Stabroek News, Dr. Carpen, who also heads the Solidarity Trial on remdesivir in the country, made this revelation when he was asked if Guyana will discontinue the use of the drug to treat COVID-19 patients based on the WHO’s pronouncement.
In its “Therapeutics and COVID-19- Living Guidelines,” which was published on November 20th, the WHO recommended that the current practice of using remdesivir to treat hospitalized patients should be discontinued based on a study.
According to the publication, “The recommendation on remdesivir was informed by results from a systematic review and network meta-analysis that pooled data from four randomized trials with 7,333 participants that were hospitalized with COVID-19”. The report added that the resulting evidence also suggested that remdesivir has no effect on mortality.
Dr. Carpen when asked about this new recommendation and the use of the drug in the country, stated that, “This is still subject to review by independent organizations and scientific bodies and so it is still a bit too early to universally change the way we do our practice not just in Guyana but across the world”.
He added that just a few days after the WHO issued its statement, there was an increase in recognition that remdesivir, when used in combination with other medications, has been found to reduce hospital Intensive Care Unit (ICU) deaths by approximately 35%. According to the doctor, they are still analyzing the data, however the report that was released following the WHO’s recommendation shows how careful medical professionals need to be when making changes to treatment and treatment protocols.
“No one has all the right answers. No country has all the right answers. Anyone who says otherwise is lying but everyone who approaches this will do so with the best intention to get the best therapeutic approach for patients,” he said.
Carpen further noted that the earliest studies had suggested that remdesivir was effective in relation to reducing the number of ICU days that patients were subjected to. He iterated that those results were also seen in Guyana. “We have seen that kind of results in Guyana with our limited use of this medication. There was never a claim that remdesivir reduces the overall mortality or the death rate,” he added.
Additionally, Dr. Carpen added that it was not surprising to see that the WHO trial did not find a mortality benefit.
He, however, added that there is still optimism that remdesivir may contribute to reduced ICU stay and in turn contribute to the reduced cost as it relates to how expensive it currently is to keep a patient in an ICU for a longer period.
Carpen told this newspaper that local authorities have not adjusted the criteria for how the drug is administered or for which patients can be administered the drug. However, he added that he does not believe that most countries that have been using the drug over the past months have yet adapted to the change that was recommended by the WHO guidelines. He stated, “I would not be surprised if people start to change but I believe that it would be dependent on some more analysis of the data that was used to arrive at this conclusion.”
Treatment protocols
Meanwhile, Carpen told Stabroek News that the general treatment protocols for COVID-19 patients that have been in place remain the same with minor “tweaks”. Some of the minor changes, he noted, include placing the use of hydroxychloroquine lower on the priority list for treatments and moving the use of convalescent plasma and supportive care higher on the priority list.
He also mentioned that the criteria for use of ventilation is now stricter, which he said came as a result of the observations showing that some of the negative outcomes were as a direct result of placing patients on ventilators too early. “So we have reserved that intervention for the very sick and those at a much later stage rather than early and that has been reflected and adopted across the world not just in Guyana,” he revealed.
With the use convalescent plasma being higher on the priority list and given the increased number of COVID-19 recoveries, he said that they have so far had a steady flow of plasma donors, although that could be better and it would improve significantly if more persons are to volunteer to donate their plasma after fully recovering from the virus.
“So that’s where we’re at in terms of treatment protocols and evolution of treatment protocols because every couple days there’s a new set of information that becomes available and you have to be able to sift through and make sense from a scientific and an analytical point of view, that this is worthy of making a change to what we already know as established practice,” Carpen added.
