A glimmer in the United States? The American Medicines Agency (FDA) has just granted an emergency use authorization for remdesivir to fight against the coronavirus.
This decision allows doctors to inject the experimental antiviral into serious patients who need oxygen without having to participate in a clinical trial. But the hope raised by this treatment is for the moment quite limited. We take stock of what we know.
What is this medicine?
Remdesivir is an experimental antiviral drug originally developed to treat patients with Ebola hemorrhagic fever by the American laboratory Gilead Sciences.
Between 2016 and 2019, a large-scale study was carried out in the Democratic Republic of Congo with disappointing results. But it was tested against Covid-19 because it had given promising results in animals against other coronaviruses like SARS or MERS.
Remdesivir will be distributed as a priority to hospitals in the cities most affected by the pandemic in the United States, a distribution to be coordinated by the United States government, Gilead said in a statement. The American laboratory, whose boss was in the Oval Office for the announcement, will donate 1.5 million doses, enough to treat at least 140,000 patients.
Is it effective?
To put it simply, the drug seems to work but it is not a miracle cure, according to the American study. The trial, which involved more than a thousand people, concludes that hospitalized patients with Covid-19 and respiratory distress recovered faster than those receiving placebo. The figure mentioned during the presentation of the study suggests a recovery rate 31% higher.
"Although the results were clearly positive from a statistical point of view, they were modest," nuanced the director of the National Institute of Infectious Diseases, Anthony Fauci, one of the White House advisers during this crisis. The mortality rate with the use of remdesivir thus drops from 11.7% to 8%. Data considered as less reliable because below the level of statistical relevance.
At the same time, another study on remdesivir had been launched in Wuhan. Caution is advised as this smaller trial, the results of which were published in the medical journal The Lancet, found no efficacy with remdesivir.
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The Chinese study involved 237 patients but was interrupted for lack of patients because the epidemic stopped in Wuhan. "The orders of magnitude of this essay are too small to draw any real conclusions," said Stephen Evans, an expert in medical statistics at the London School of Hygiene & Tropical Medicine.
How does remdesivir work?
Remdesivir is an injectable drug that attacks the virus directly. It inserts itself into the coronavirus genome and short-circuits it to prevent it from replicating.
"By limiting the replication of the virus, we will limit the inflammation, we will reduce the number of people who develop lung problems," said Gilead medical manager Merdad Parsey. We will therefore be able to disconnect them from the respirators more quickly. ”
The drug is given intravenously for 10 days, but emergency clearance covers treatment in five days, as a study by Gilead showed that the effect was similar.
Is it used in France?
Nearly 440 trials to try to find an effective treatment against Covid-19 were launched in mid-April in France. Among these, several working groups are still studying the effects of remdesivir. The results are not yet known.
The drug is nevertheless already used in France. At the end of March, the High Council for Public Health also recalled that in the absence of a specific treatment, "a treatment may be considered in the presence of signs of severity using a molecule with antiviral effect "including remdesivir" in the most severe cases ". One of the first patients in France, that of Bordeaux, had been treated with this drug.
