IDSA continues to recommend remdesivir for COVID-19, departing from WHO
The Infectious Diseases Society of America said it will continue to recommend remdesivir for patients with severe COVID-19 despite a guideline from WHO last week that recommended against its use in any hospitalized patients.
During a teleconference, Rajesh T. Gandhi, MD, a member of the IDSA’s expert panel on COVID-19 treatment and management guidelines and an ID physician at Massachusetts General Hospital, said the reason for maintaining the recommendation for remdesivir was that results from the ACCT-1 trial showed an improved time to recovery in hospitalized patients.
Gandhi noted that the international Solidarity trial, which was used as the basis for WHO’s recommendation against remdesivir, did not assess time to recovery — an important consideration in ensuring the U.S. health care system is not overwhelmed as the pandemic continues.
“We think that has an important benefit as our hospitals fill up. It's not as important as survival, and remdesivir is not a home run — we do need better drugs,” Gandhi said. “But the IDSA panel feels that the benefit in terms of speeding up time to recovery — going from 15 days on average with placebo down to 10 days with remdesivir — that's an important benefit.”
The IDSA also issued a conditional recommendation against routine use of the monoclonal antibody therapy bamlanivimab — which was granted an emergency use authorization (EUA) by the FDA this month — but noted it may be used in patients who have an increased risk for severe COVID-19.
The FDA this past weekend also issued an EUA for the monoclonal antibodies casirivimab and imdevimab. Gandhi said the initial results look “similar to bamlavinimab."
"We want to be cautious as a guideline panel before issuing guidelines without looking at the totality of the data,” he said.
After considering data from five randomized controlled trials, the IDSA also maintained its guideline recommending against the routine use of tocilizumab in hospitalized patients with COVID-19.
Adarsh Bhimraj, MD, FIDSA, section head of neurologic infectious diseases at Cleveland Clinic and first author of the IDSA’s COVID-19 management and treatment guidelines, said it is important that vulnerable populations be considered when distributing new COVID-19 therapies, and emphasized that the public [should continue] to practice social distancing and mask wearing.
“The most important thing is flattening the curve,” Bhimraj said. “If you look at mortality in Italy and New York City, it was highest when hospital systems were overwhelmed. When hospital systems were able to manage, the mortality went down. It is absolutely important that we have adequate supplies like ventilators, but I can't emphasize enough the importance of flattening the curve.”
IDSA. Infectious Diseases Society of America guidelines on the treatment and management of patients with COVID-19. https://www.idsociety.org/practice-guideline/covid-19-guideline-treatment-and-management/. Accessed November 23, 2020.