No change in how Covid-19 drug remdesivir is used in Singapore despite WHO advice

NCID was responding to a recommendation by the WHO that stated the drug should not be used to treat Covid-19 patients. PHOTO: REUTERS

SINGAPORE - There is no change in the way antiviral drug remdesivir is being used to treat Covid-19 patients here, as it is relatively safe and has potential benefit for some people, the National Centre for Infectious Diseases (NCID) said.

It was responding to a recommendation by the World Health Organisation (WHO) on Nov 20 that the drug should not be used to treat Covid-19 patients, no matter how severe their illness, as it has "no important effect" on survival chances.

In a statement to The Straits Times on Tuesday (Dec 1), NCID said: "Remdesivir is available in Singapore, and given its relatively safe profile and potential benefit in some patients, clinicians can exercise discretion of its use in treating Covid-19 patients. There is no significant change at the current stage in our approach to therapeutic treatment for patients with Covid-19."

Remdesivir, developed by US drugmaker Gilead Sciences, received conditional approval by Singapore's Health Sciences Authority to be used outside of clinical trials in June.

Infectious disease specialists can administer it to Covid-19 patients with low oxygen saturation levels, less than or equal to 94 per cent, or those who might require supplemental oxygen or more intensive breathing support.

WHO, however, recommended against the use of remdesivir, given the weak evidence that it improves survival and other outcomes in patients who are hospitalised.

The recommendation was developed by an international guideline development panel comprising 28 individuals - 24 content experts such as clinicians, methodologists and scientists, and four Covid-19 survivors. NCID's executive director, Professor Leo Yee Sin, is one of the panel members.

"Although the analysis did not reveal evidence to support the use of remdesivir in patients with Covid-19 regardless of disease severity, the evidence against its use was noted to be weak," said the NCID statement.

Sub-group analysis - where study samples are broken down into smaller subsets - from the United States National Institutes of Health's adaptive Covid-19 treatment trial ,as well as WHO's Solidarity study involving patients requiring low amount of oxygen, suggested that remdesivir provided some benefit, noted NCID.

However, it was judged that the sub-group analysis itself was insufficient to make recommendations, NCID added.

"The report (WHO's recommendation) also recognised the lack of evidence regarding the increased risk of serious adverse events in patients receiving remdesivir.

"The role of remdesivir in future clinical trials and research is not negated by this report," it said.

"Covid-19 therapeutics is a rapidly moving field and the NCID Covid-19 therapeutic workgroup will continue to monitor and deliberate on the recent data and WHO recommendation... Singapore's current approaches on early case detection, close monitoring of disease progression to allow early intervention at the appropriate time point must be continuously emphasised."

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