Rejected by WHO, applauded by Bangladesh – why is remdesivir still being used?

Despite the World Health Organization's (WHO) recommendation against the use of the antiviral drug remdesivir for critical Covid-19 patients, Bangladeshi physicians are still administering it.

Doctors say use of remdesivir in the early stages of Covid-19 treatment sometimes shows positive results. They say they are using the locally manufactured drug due to "push selling" of the pharmaceutical companies and "requests by relatives" of patients.

"Many doctors are using remdesivir in a random manner, sometimes even in the absence of any medical emergency," an intensive care unit (ICU) specialist told The Business Standard on condition of anonymity.

Remdesivir started out as an antiviral treatment for Hepatitis C and Ebola and was also tested for SARS and MERS. It was thrust into the spotlight when the Covid-19 pandemic hit the globe, making the drug a household name.

But in November last year, WHO recommended against its use in Covid-19 patients regardless of the severity of the disease. WHO noted that there was no evidence that remdesivir improved the survival of coronavirus patients.

The recommendation was based on WHO's Solidarity Trial on more than 11,000 patients in 30 countries. The WHO panel said data from the trial showed that remdesivir had "no meaningful effect on mortality or on other important outcomes for patients".

"Everyone knows the name of remdesivir due to the media campaign. So, when the condition of a patient deteriorates, relatives ask us to administer the drug," the ICU expert told TBS.

In October last year, remdesivir gained ever more prominence when it was given to then US President Donald Trump as part of his treatment after he had contracted the virus.

In November last year, Jozef Kesecioglu, president of the European Society of Intensive Care Medicine, told Reuters that remdesivir had been classified as a drug one should not use routinely on Covid-19 patients.

Dr Shoman Aniruddha, an anaesthesiologist at the ICU of Mugda General Hospital, told TBS that the hospital had been treating patients according to WHO and health directorate protocols.

"Even then, remdesivir is administered owing to the medical urgency of the patients. Besides, we are getting better results by using drugs that are not in WHO's protocol. Moreover, WHO changes the treatment protocol regularly," said the physician.

Dr Aniruddha said Covid-19 treatment still had no specific medication except oxygen and blood thinners. The antiviral drug could obtain promising results if administered in the early stages when the viral load increased.

Meanwhile, Professor Sayedur Rahman, chairman of the Bangladesh Pharmacological Society, said the WHO protocol was voluntary in nature and countries did not have any obligation to comply with it fully.

Noting that timing is crucial in remdesivir use, he said there is no problem if physicians use any medicine beyond the WHO protocol for the benefit of patients.

In Bangladesh, the price of each vial of remdesivir is Tk5,000-6,000. A patient usually requires five to 10 vials – which means the antiviral medicine costs around Tk60,000 for each patient.