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"Remdesivir Is Probably Worthless" - A Trauma Surgeon Exposes "Drug Company's Shenanigans"
Markets got very excited (briefly) this week about a study finding a Gilead Sciences drug helped coronavirus patients heal a little more quickly.
But that was all the trial found: remdesivir isn’t the miracle cure that will get us all out of lockdowns tomorrow, unfortunately.
Worse, as Bloomberg's Faye Flam writes, the trial was rushed to get quick FDA approval, without getting helpful information on what kinds of patients it helps or hurts the most; and now that the study is over, we’ve forever lost a chance to help doctors treat virus patients better.
All of which raises a significant number of questions and Acute Care Surgeon (and Asst Professor of Surgery at Wash U.) Mark Hoofnagle warns "I am truly sorry to say, Remdesivir is probably worthless…"
In an excellent Twitter thread, Hoofnagle details what he calls "some fascinating drug company shenanigans."
First, the pre-test probability that an infused, small-molecule inhibitor of a virus would improve mortality in symptomatic patients was already pretty low. Unfortunately, antivirals work poorly in acute disease. This has to do with their mechanism of action, and host response.
Antivirals usually target some aspect of viral replication/assembly/transmission. Remdesivir is a clever pharmacologic prodrug that inhibits a key piece of RNA viruses that mammals don’t have - the RNA-dependent RNA polymerase, and inhibits viral replication.
Unfortunately, by the time you are symptomatic with a virus, you are usually already high/peak viral load. So, when you give an antiviral to someone who is already ill, the damage from the virus is largely done.
It’s there in big numbers and in the cells.
Consistent with this, the Lancet paper on the remdesivir trial in China shows no impact on viral load clinically.
https://www.zerohedge.com/health/remdesivir-probably-worthless-trauma-surgeon-exposes-drug-companys-shenanigans