Experts differ on COVID-19

Health officials around the world express differences on the use of certain drugs for COVID-19, leading to different treatments according to where patients live.

A World Health Organization panel advised against treating hospitalized patients with the antiviral medicine remdesivir, saying there is no evidence that it improves the chances of survival or prevents the need for using a ventilator.

But in the United States and many other countries, the substance has been the standard treatment since a large government-ordered study found it has other benefits: It reduces patients’ recovery time by an average of five days – from 15 to 10 days.

In the United States, a federal panel that develops the guidelines and several major medical associations do not endorse two therapies authorized by the Food and Drug Administration (FDA) for use in an emergency: an experimental antibody-based medicine. from Eli Lilly and plasma taken from COVID-19 survivors. The associations say there is insufficient evidence for or against its use.

Doctors are also not certain about when to use or not use the only drugs known to improve the chances of survival of the most severely ill: dexamethasone or similar steroids.

Adding to the confusion, it was reported Thursday that the anti-inflammatory tocilizumab might be helpful. Like the WHO remdesivir study, preliminary results on tocilizumab have not yet been published or fully reviewed by independent scientists, so doctors don’t know what to do.

“It’s a real dilemma,” said Dr. Derek Angus of the University of Pittsburgh, who is involved in a study on many of these treatments. “We need to know the details.”

Dr. Rochelle Walensky, chief of infectious diseases at Massachusetts General Hospital, agrees. “It is very difficult to practice medicine based on press releases,” he said on a podcast Thursday. Until the National Institutes of Health endorses a treatment, “I am very reluctant to adopt that guideline.”

Angus said there are legitimate doubts about all the studies. “The lack of agreement between professional guidelines is not unusual, it’s just that with COVID-19 everything is under the microscope,” he said.

The most serious difference is around remdesivir, which Gilead Sciences Inc. sells under the Veklury brand. The WHO guide emphasizes that the drug does not save lives, based on a larger study – although much less rigorous – than the American one that found other benefits.

The substance is usually given intravenously for about five days, and its high cost and lack of “significant effect” on mortality mean it is a poor choice, according to the WHO panel.

Gilead charges $ 3,120 for typical treatment for patients with private insurance and $ 2,340 for patients covered by public health insurance in the United States and other developed countries. Much cheaper generic versions are sold in low- and middle-income countries.

Price can also depress demand. In October, US health officials said hospitals had bought just a third of the doses of remdesivir offered to them in previous months, when there was a shortage of the medicine.

Meanwhile, on Thursday the FDA gave emergency authorization to another anti-inflammatory drug, baricitinib, to be supplied along with remdesivir. This reduced the average recovery time of seriously ill hospitalized patients by one day, according to a study.

Lilly sells baricitinib under the brand name Olumiant to treat rheumatoid arthritis, a less common variant of arthritis that occurs when the immune system overreacts, affecting the joints.