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Remdesivir can help COVID patients avoid the hospital. But it's been slow to catch on


With early treatment for COVID-19, many high-risk patients can avoid the hospital, but the limited supply of medicines has added to the stress on hospitals in this omicron surge. One antiviral treatment is an ample supply. But so far, it hasn't gotten much traction for reasons NPR's Pien Huang explains.

PIEN HUANG, BYLINE: In late December, the roster of COVID treatments was looking slim. New COVID pills were hard to get, and some antibody drugs didn't seem to work. Dr. Jane Kelly, assistant state epidemiologist for South Carolina, said one bright spot was the news about the antiviral drug remdesivir.

JANE KELLY: Remdesivir given as an outpatient - meaning given, you know, earlier in the course of disease - is highly effective in preventing progression to severe disease.

HUANG: For a year and a half, remdesivir has been used in hospitals to help very sick patients recover from COVID. New data from the drugmaker Gilead showed remdesivir could also help high-risk patients avoid the hospital. Here's Dr. Kelly.

KELLY: The really remarkable thing is it resulted in an 87% lower risk of hospitalization or death than placebo. So that's truly dramatic.

HUANG: Those results put remdesivir up there with the best early COVID treatments available. And the side effects, mainly nausea, are pretty tame for most people. The FDA added it to the tiny list of drugs for treating early COVID, and the big plus is that there's plenty of remdesivir to go around. But it's harder to give out, and it costs a lot, which stands in the way of widespread use. For starters, Dr. Cameron Wolfe of Duke University Hospital says, remdesivir has to be given through IV infusion.

CAMERON WOLFE: Where do we find a place that can house an infectious individual and give them three doses in a row?

HUANG: A lot of infusion clinics were set up to give out monoclonal antibodies, which take just one session. But remdesivir takes three infusion sessions, one to two hours each, on consecutive days. That means a clinic could treat one patient with remdesivir or three patients with antibodies in the same amount of time. Dr. Peter Chin-Hong of University of California, San Francisco, says there's also the issue of upfront costs.

PETER CHIN-HONG: You know, it's also not provided for free. You have to bill Medicare. You have to bill patients' insurance. That might be a consideration to somebody who might be slapped with a copay.

HUANG: Remdesivir is the only early treatment that's not distributed by the U.S. government or sent to health care providers for free. It's available on the commercial market, which means clinics pay $2,000 for the drug upfront. And putting it into someone's arm adds to the cost. Erin Fox, a pharmacy director at University of Utah Health, says that could lead to big copayments for some patients with health insurance and no access to the drug for those without.

ERIN FOX: You know, it's hard enough already with these COVID treatments. You're trying to make sure that the patients qualify, they've got their positive test, you know, they're kind of within that symptom window. But then with remdesivir, you have that added challenge of trying to assure payment.

HUANG: Fox says her health system has treated about 15 patients with remdesivir so far. A surprise shipment of sotrovimab, the free antibody treatment, has put remdesivir on the back burner for now.

FOX: We have it. We want to be able to use it, but we're kind of turning it on and off based on how much sotrovimab we're getting.

HUANG: Michael Ganio with the American Society of Health System Pharmacists says remdesivir his role may be short-lived.

MICHAEL GANIO: I think stopgap is probably a good word. Three days of - consecutive days of infusion is a very difficult ask when you have on the horizon, hopefully, more sotrovimab supply.

HUANG: The supply of take-at-home COVID pills is also expected to get better this spring. Ganio expects those treatments to be preferred. Still, he says, remdesivir has been clutch in this omicron surge, when virus mutations knocked out a few treatment options. And as the virus evolves, it could be key again.

Pien Huang, NPR News. Transcript provided by NPR, Copyright NPR.

Pien Huang is a health reporter on the Science desk. She was NPR's first Reflect America Fellow, working with shows, desks and podcasts to bring more diverse voices to air and online.