COVID-19 SPECIAL

Patients in Singapore with severe Covid-19 enrolled in drug trials

About 90 of them are in trials of remdesivir; HIV drugs no longer being used here to fight virus

Remdesivir has been shown to accelerate the recovery of patients in randomised trials. PHOTO: REUTERS

About 90 severely ill Covid-19 patients here have been enrolled in trials of remdesivir, an antiviral drug originally designed to combat Ebola, which recently has shown promise in fighting the coronavirus.

The director of the National Centre for Infectious Diseases' Infectious Disease Research and Training Office, Associate Professor David Lye, told The Straits Times last Wednesday that as of May 8, the patients, who require oxygen support, were enrolled in three trials - two by drugmaker Gilead Sciences and one by the National Institute of Allergy and Infectious Diseases in the United States.

Singapore enrolled its first patient in these trials on March 12. Remdesivir is currently available only through such clinical trials.

Prof Lye explained that remdesivir, which needs to be given as an intravenous injection to patients for five to 10 days, works by blocking an enzyme that is necessary for the Covid-19-causing virus to multiply.

The drug was originally designed for Ebola but did not work as well on the disease as other treatments. However, experiments later proved its effectiveness against the Middle East respiratory syndrome-related coronavirus.

Remdesivir has also been shown to work against Covid-19 in monkeys in a laboratory setting, and the drug has also accelerated the recovery of patients in randomised trials.

However, Prof Lye cautioned: "While remdesivir is effective, it is not a magic bullet as it has not been shown to significantly reduce death."

Meanwhile, antiretroviral drugs lopinavir and ritonavir are no longer being used to treat Covid-19 patients here.

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The Ministry of Health's chief scientist had said in February that a small number of such patients had been treated with a combination of the drugs, which are usually used to treat patients with the human immunodeficiency virus (HIV) that causes Aids.

But Prof Lye said this is no longer the practice, as a recent randomised controlled trial had shown that the cocktail of drugs did not work.

Malaria drugs chloroquine and hydroxychloroquine, which had shown some early promise against Covid-19, are also not commonly used here as some studies had found that in addition to not working, they were also associated with side effects.

Hydroxychloroquine had previously been touted by US President Donald Trump as having tremendous promise in treating Covid-19, prompting Americans and people elsewhere to snap it up.

Prof Lye said randomised controlled trials with a control group of patients not receiving the drugs are needed to test and prove that a treatment works.

He added that aside from drugs, antibodies identified from recovered patients which can be manufactured to target the virus behind Covid-19 are being developed by scientists here and overseas.

Antibodies collected from recovered patients have also been given to sick patients - a form of treatment known as convalescent plasma therapy.

However, Prof Lye said this therapy has yet to be tested in a randomised controlled trial.

He said: "The main treatment for Covid-19 in Singapore is actually good medical care, which has kept the number of deaths low."

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A version of this article appeared in the print edition of The Straits Times on May 18, 2020, with the headline Patients in Singapore with severe Covid-19 enrolled in drug trials. Subscribe