Clarify Remdesivir’s and Convalescent Plasma’s Role for COVID-19

Posted September 16, 2020: Article in Progress. We’re releasing this article ahead of our October 2020 issue to quickly provide information to our readers. The information contained in this version is based on the best evidence available to us as of the date of posting. The final version may include revised recommendations.

You’ll hear buzz about emergency use authorizations (EUAs) for remdesivir and convalescent plasma to treat COVID-19.

Remdesivir (Veklury). FDA is expanding the EUA to include ALL hospitalized patients with suspected or confirmed COVID-19.

But there isn’t enough evidence yet to be certain there’s a benefit in nonsevere patients.

For now, continue to consider remdesivir to shorten recovery time in COVID-19 patients requiring supplemental oxygen.

Think about prioritizing patients who may benefit most...those NOT yet on high-flow oxygen, mechanical ventilation, or extracorporeal membrane oxygenation (ECMO).

Keep in mind, there’s no good evidence so far that remdesivir decreases mortality.

Convalescent plasma. A new EUA allows use in any hospitalized COVID-19 patient...and should provide hospitals easier access.

You may hear reports in the media that convalescent plasma decreases mortality by 35%. But this is misleading.

Explain this is based on a comparison of convalescent plasma with high antibody titers to low titers...not to other COVID-19 treatments or placebo.

And point out that this is a RELATIVE reduction...ABSOLUTE risk reduction is about 5%. Also clarify that this is based on observational data that aren’t peer reviewed yet.

Educate that it’s too soon to say if high-titer convalescent plasma improves outcomes over your current treatment protocols.

Generally save convalescent plasma use for clinical trials.

But if used outside a trial, give patients the EUA fact sheet. Explain risks seem similar to other plasma infusions...based on use in over 70,000 patients so far.

See our chart, COVID-19 and Pharmacotherapy, for updated evidence to further support the role of steroids... and for details on where to donate convalescent plasma, EUA specifics, and more.

References

  1. JAMA. 2020 Aug 21;e2016349
  2. https://www.medrxiv.org/content/10.1101/2020.08.12.20169359v1.full.pdf
  3. https://www.fda.gov/news-events/press-announcements/fda-issues-emergency-use-authorization-convalescent-plasma-potential-promising-covid-19-treatment
  4. https://www.covid19treatmentguidelines.nih.gov