WHO says no to Remdesivir, plasma therapy


The World Health Organisation has recommended against using antivirals including much-talked-about Remdesivir for the treatment of the Covid-19.

In its latest clinical guidelines, the UN health agency also suggested not to use plasma therapy as “treatment option outside of the context of clinical trials”.

The latest guidelines come at a time when few pharmaceutical companies are promoting the use of Remdesivir for Covid-19 treatment in Bangladesh.

Plasma therapy also gained popularity in different hospitals after Dhaka Medical College Hospital started a study drawing media attention.

The WHO did not approve any antivirals before for the treatment of the new coronavirus.

The latest document updated on May 27 said their earlier recommendation has not changed and is “consistent with previous WHO guidance documents and other international grade-based guidelines.” 

The new clinical guideline for doctors was developed by a multidisciplinary panel of health care providers with experience in the clinical management of patients with COVID-19 and other viral infections, including severe acute respiratory virus (SARS) and Middle East respiratory virus (MERS), as well as sepsis and acute respiratory distress syndrome (ARDS).

The WHO said this guidance should serve as a foundation for optimised clinical care to ensure the best possible chance for survival.

The guidance stresses the importance of “using investigational therapeutic interventions as part of randomized controlled trials (RCTs)”.

It also suggested doctors in areas with other endemic infections that cause fever such as malaria, and dengue, “febrile patients should be tested and treated for those endemic infections per routine protocols, irrespective of the presence of respiratory signs and symptoms. Co-infection with COVID-19 may occur.”

On Remdesivir and other antivirals, WHO said existing published literature is mostly “observational” in nature, with few clinical trials; and does not provide “high-quality evidence in favour of any of these agents”.

“In addition, important side-effects have been described.”

For Remdesivir, the side effects include “elevation of hepatic enzymes, GI (gastrointestinal) complications, rash, renal impairment and hypotension.

Prof Meerjady Sabrina Flora, director of the government’s disease monitoring agency IEDCR, told Bangladesh Post they did not recommend any of those drugs to patients for treatment.

She is also the member secretary of the national technical advisory committee on Covid-19.

“The IEDCR made it clear before that those can be used as trials, not for confirmed treatment. And doctors who will conduct those trials will take consent from patients and then it’s up to patient whether they want to take part or not,” she said.

“But it’s not that you’ll use it (antivirals or plasma therapy) invariably for all patients. Still there is no specific treatment,” she said.

“Anybody wants to conduct trails of drug, they will have to take approval from the national review committee,” she said.

“It’s true for all drugs,” she said, when asked about the Ivermectin which a doctor in Bangladesh claimed to be useful for coronavirus patients in combination with another drug.

On plasma therapy, Prof Flora said, they don’t suggest plasma therapy since it is still not sure whether antibody develops or not in Covid-19 patients.

“Still there is confusion in that (antibody development). There is confusion whether its beneficial at all.”

“To those who get plasma therapy, there are issues related to proper screenings so that other infections cannot pass into them. There are chances of auto-immuno reactions which can be harmful”.

“DMCH is the approved study place so far for plasma therapy. But for other centers, we did not suggest them. So they should control their use of plasma therapy”.

The upcoming version of the national technical committee guideline will include all those issues, she said.

The last meeting for the seventh version of the national guideline was held on Wednesday.

WHO earlier warned against using anti-malaria drug chloroquine and hydroxychloroquine for Covid-19 patients.

As of Friday, Bangladesh confirmed 42,844 coronavirus cases and 582 deaths.

The WHO said most of the people with COVID-19 develop only mild (40%) or moderate (40%) disease.

Approximately 15% develop severe disease that requires oxygen support, and 5% have critical disease with complications such as respiratory failure, acute respiratory distress syndrome (ARDS), sepsis and septic shock, thromboembolism, and/or multiorgan failure, including acute kidney injury and cardiac injury.

Older age, smoking, and underlying noncommunicable diseases, such as diabetes, hypertension, cardiac disease, chronic lung disease and cancer have been reported as risk factors for severe disease and death.

The WHO also recommended against antibiotic therapy or prophylaxis for patients with ‘mild’ COVID-19.

“Widespread use of antibiotics should be discouraged, as their use may lead to higher bacterial resistance rates, which will impact the burden of disease and deaths in a population during the COVID-19 pandemic and beyond”.

“We recommend that patients with suspected or confirmed moderate COVID-19 (pneumonia) be isolated to contain virus transmission," WHO said.

“Patients with moderate illness may not require emergency interventions or hospitalization; however, isolation is necessary for all suspect or confirmed cases.

“The location of isolation will depend on the established COVID-19 care pathway and can be done at a health facility, community facility or at home.

“The decision of location should be made on a case-by-case basis and will depend on the clinical presentation, requirement for supportive care, potential risk factors for severe disease, and conditions at home, including the presence of vulnerable persons in the household.

“For patients at high risk for deterioration, isolation in hospital is preferred.