Clarify Remdesivir and Convalescent Plasma Use for COVID-19

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 currently isn't enough evidence to be certain of a benefit in nonsevere patients...and a 5-day course costs over $3,000.

For now, continue to consider remdesivir in COVID-19 patients requiring supplemental oxygen...to shorten recovery by a few days.

Think about prioritizing oxygen-requiring 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 that 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. Be aware, enrollment varies. For example, some include any hospitalized COVID-19 patient...others limit to those on supplemental oxygen.

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

See our chart, Treatments of Interest for COVID-19, for more on limitations of remdesivir data in nonsevere patients...EUA specifics...and for updated evidence to further support steroid use.

Key References

  • JAMA 2020;324(11):1048-57
  • medRxiv Published online Aug 12, 2020; doi:10.1101/2020.08.12.20169359
  • www.fda.gov/news-events/press-announcements/fda-issues-emergency-use-authorization-convalescent-plasma-potential-promising-covid-19-treatment (9-25-20)
  • www.covid19treatmentguidelines.nih.gov (9-25-20)
  • Medication pricing by Elsevier, accessed Sep 2020
Hospital Pharmacist's Letter. October 2020, No. 361022



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