Know the Roles of Remdesivir and IL-6 Inhibitors for COVID-19

You'll get questions about remdesivir or interleukin-6 (IL-6) inhibitors for hospitalized COVID-19 patients.

Remdesivir is an investigational IV antiviral with in vitro activity against the SARS-CoV-2 virus that causes COVID-19.

Observational data suggest improvements in oxygenation. And a recent trial in severe COVID-19 patients with pneumonia shows no benefit...but it was stopped early due to low enrollment.

New preliminary, unpublished data from an ongoing trial suggest remdesivir shortens recovery time by a few days in COVID-19 patients versus placebo. But so far, it doesn't improve mortality.

Explain there are limitations with all available data.

Continue to enroll in clinical trials if using remdesivir.

FDA now has an "emergency use authorization" (EUA) for severe, hospitalized patients. This doesn't mean that remdesivir is FDA-approved for COVID-19...but does provide access to the med for government-identified hospitals.

The EUA requires sharing med risks and benefits with the patient using its "fact sheet"...and reporting adverse events via MedWatch.

Point out the manufacturer's expanded access program for COVID-19 patients is phasing out...but compassionate use for severely-ill kids and pregnant patients will continue.

IL-6 inhibitors currently being investigated in the U.S. include tocilizumab (Actemra) and sarilumab (Kevzara).

The theory is that these injectable monoclonal antibodies will help manage the "cytokine storm" seen in some COVID-19 patients.

But there isn't much evidence...and these immunosuppressants have a risk of serious infections, neutropenia, etc.

Avoid using IL-6 inhibitors outside of a clinical trial.

Otherwise, work with specialists to save these meds as a last resort for critically ill COVID-19 patients with a severe inflammatory response...elevated ferritin, IL-6, etc.

Get our chart, COVID-19 and Pharmacotherapy, for the scoop on other therapies... hydroxychloroquine, convalescent plasma, etc. And see our Coronavirus (COVID-19) Resource Hub for more.

Key References

  • Lancet Published online April 29, 2020; doi:10.1016/ S0140-6736(20)31022-9
  • www.niaid.nih.gov/news-events/nih-clinical-trial-shows-remdesivir-accelerates-recovery-advanced-covid-19 (5-1-20)
  • N Engl J Med Published online Apr 10, 2020; doi:10.1056/NEJMoa2007016
  • https://clinicaltrials.gov/ct2/show/NCT04323761 (5-1-20)
  • www.chinaxiv.org/user/download.htm?id=30387 (5-1-20)
Hospital Pharmacist's Letter. May 2020, No. 360520



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