A Brigham & Women’s doctor just explained what it’s like to treat patients with remdesivir

A vial of the drug remdesivir,ULRICH PERREY/POOL/AFP via Getty Images

A Boston doctor participating in a clinical trial for an antiviral drug given emergency approval to treat COVID-19 patients shared his observations about the medication on social media Tuesday night.

Dr. Francisco Marty, an infectious disease specialist at Brigham and Women’s Hospital and the Dana Farber Cancer Institute, made a series of Twitter posts offering his experience using remdesivir to treat nearly 200 patients.

Stressing that his observations are anecdotal, Marty said he has heard multiple COVID-19 patients say things like, “This juice works, Doc!” within one or two days of beginning remdesivir treatment. “Don’t recall a similar proportion of patients smile after feeling so sick 1-2 days earlier with #COVID19,” he said.

#Remdesivir begins distribution in the #USA today via #EUA.

I thought would write down some practical #tips based on my #qualitative anecdotal experience after personally treating close to 200 patients with #COVID19.

For quantitative results, wait for the papers¬—thread pic.twitter.com/HMoEbhjhU7

— Francisco Marty, MD (@FranciscoMarty_) May 5, 2020

Like #treatment for any severe infectious disease (meningitis, Gram-negative bacteremia, influenza pneumonia, etc), earlier is always better. #COVID19 is no different. #Remdesivir stops #SARS-CoV2 replication, but won’t heal the lung injury.

— Francisco Marty, MD (@FranciscoMarty_) May 5, 2020

So my preference on when to use #remdesivir? Use it early in severe #COVID19 disease, anyone with an abnormal chest X-ray that drops to SpO2 <94%: limit the lung injury, get patients home in 2-4 days, not 2 to 4 weeks.

— Francisco Marty, MD (@FranciscoMarty_) May 5, 2020

Patients who end up in the #ICU on mechanical ventilation with #COVID19 likely benefit too given the #ACTT DSMB disclosed info to investigators, but the lung damage is already advanced and takes time to heal, no different that other #lung infections

— Francisco Marty, MD (@FranciscoMarty_) May 5, 2020

The risk of #hepatotoxicity with #remdesivir is real, 3% of patients needing discontinuation for Hy’s law criteria quoted in the #NIAID press release. Lots of #COVID19 patients come with high ALT/AST though. If <5xULN, treat them, enzymes go down.

— Francisco Marty, MD (@FranciscoMarty_) May 5, 2020

#Cyclodextrine is dialyzable. Although excluded from the study protocols, I would use #remdesivir without qualms in patients on #hemodialysis or #CVVH with severe #COVID19. The #EUA is silent on renal function, risk/benefit.

— Francisco Marty, MD (@FranciscoMarty_) May 5, 2020

Pandemic times—we get to use #remdesivir before all the data is out.#COVID19 is not the #flu & #remdesivir is not #oseltamivir, I think is much better.
We must continue public health measures, get effective #vaccines. This is a first tool delivered to all today, full data soon.

— Francisco Marty, MD (@FranciscoMarty_) May 5, 2020

Since March, both Brigham and Women’s and Massachusetts General Hospital have been conducting separate clinical trials on remdesivir, which targets the way the virus replicates itself and spreads within a living being.

The US Food and Drug Administration on Friday granted emergency approval for the drug to be used to treat patients after a government-sponsored study showed it shortened the recovery time for patients hospitalized with COVID-19.

Marty, who also teaches at Harvard Medical School, recommended physicians begin treatment with remdesivir as early as possible in severe cases, saying it will stop the virus from replicating itself but won’t heal the serious damage done to patients’ lungs.

That damage, Marty said, “is nasty and slow to heal, slower that any pneumonic process I ever recall in 25 years in medicine. Patients feel great, appetite comes back, all pains and fevers are gone, but the lung heals slowly.”

Marty said doctors shouldn’t make decisions about who gets the drug based on a patient’s age, immune health, or preexisting conditions.

“If they are sick enough to be in the hospital with #COVID19, sick enough to treat,” he said, adding that all patient groups, regardless of age, including cancer and transplant patients, respond to the drug.

Even those placed on ventilators are likely to benefit, he said, though they will already have advanced lung damage that will be slow to heal.

Some patients given remdesivir early have been able to leave the hospital without even completing a five-day course of the drug, and still the virus has not reoccurred in those patients, he said.

He cautioned, though, that the drug carries a risk of damage to the liver and kidneys. About 3 percent of patients have to discontinue the drug because of its effects on the liver, he said.

Though all the data on remdesivir is not yet available, Marty said, he thinks it is a “much better” treatment for COVID-19 than oseltamivir, the drug marketed as Tamifu, is for treating the flu.

“We must continue public health measures, get effective #vaccines,” he said in closing his Twitter thread. “This is a first tool delivered to all today, full data soon.”