{"id":10295,"date":"2021-12-20T11:42:46","date_gmt":"2021-12-20T16:42:46","guid":{"rendered":"https:\/\/blogs.nejm.org\/hiv-id-observations\/?p=10295"},"modified":"2021-12-21T15:59:26","modified_gmt":"2021-12-21T20:59:26","slug":"we-already-have-a-highly-effective-outpatient-antiviral-treatment-for-covid-19","status":"publish","type":"post","link":"https:\/\/blogs.nejm.org\/hiv-id-observations\/index.php\/we-already-have-a-highly-effective-outpatient-antiviral-treatment-for-covid-19\/2021\/12\/20\/","title":{"rendered":"Believe It or Not, We Already Have a Highly Effective Outpatient Antiviral Treatment for COVID-19"},"content":{"rendered":"
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A pine tree. With a colorful birdhouse.<\/p><\/div>\n

And that treatment is … (drum roll) … remdesivir.<\/em><\/p>\n

Yes, you heard me right. Remdesivir, the very same antiviral with a checkered history in COVID-19 clinical trials, with some studies showing efficacy<\/a> (sort of), others not much of anything<\/a>.<\/p>\n

What’s the truth here?<\/p>\n

For that, let’s turn to what gets my vote for the most unheralded highly favorable clinical trial result since the start of the pandemic, the PINETREE study<\/a>.<\/p>\n

The trial randomized 562 outpatients with an increased risk for severe COVID-19 to daily intravenous remdesivir for 3 days or placebo. None had vaccination or treatment with monoclonal antibodies.<\/p>\n

The results were unequivocally positive — remdesivir-treated patients had an 87% reduction in the risk of hospitalization or death, with no significant treatment-related toxicities. Key figure from the IDWeek 2021 late breaker presentation<\/a>:<\/p>\n

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The contrast with the so-so results of the drug in hospitalized patients is striking, and underscores the importance of early antiviral treatment for this disease. By the time the immune-mediated organ damage kicks in — which is when most hospitalizations take place — it’s often too late for antivirals to have any effect.<\/p>\n

Note that remdesivir given early in the course of illness to outpatients yields comparable results to the monoclonal antibodies and nirmatrelvir plus ritonavir (Paxlovid), and better results than molnupiravir. (Yes, caveats about cross-study comparisons understood.) Furthermore, remdesivir has been available for months, and is the only fully FDA-approved treatment for COVID-19 — which means clinicians can prescribe it in whatever setting they deem useful.<\/p>\n

But it’s hard — OK, nearly impossible — to find anyone who has actually used remdesivir in a nonhospitalized patient:<\/p>\n

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The PINETREE study showed that remdesivir daily for 3 days in nonhospitalized, high-risk individual with Covid19 reduced the risk of hospitalization by 87%.
Have you or anyone you know used it this way outside of a research study? https:\/\/t.co\/o9e0IBPH0F<\/a><\/p>\n

— Paul Sax (@PaulSaxMD) December 19, 2021<\/a><\/p><\/blockquote>\n