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.
- 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