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Use of Early Remdesivir to Prevent Progression of COVID-19 to Severe Disease When Given in the Outpatient Setting

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We need more options to treat the latest COVID-19 variant of concern, Omicron. This is because the two previously used COVID-19 monoclonal antibody (CmAb) combinations, Regen-Cov and BAM/ETE have little activity and what does still work is largely unavailable.

But there is some good news about an approved treatment that is available now if you test positive for COVID-19.

Remdesivir was the first drug approved to treat COVID-19 and has been used since October 2020. The truth is that it has only been marginally helpful for very sick patients hospitalized with severe disease.

However, its use for severe disease might not be the best setting.

Early intervention in outpatients with mild disease but at high risk for progression (such as those with CLL / SLL) was recently shown to dramatically reduce the risk of progressing to severe disease resulting in hospitalization.

While we have been anxiously awaiting the authorization and distribution of oral anti-viral medications (such as Paxlovid or Molnupiravir) to arrive at pharmacies and for the government to provide adequate supplies of sotrovimab (the only monoclonal antibody still active against Omicron that is authorized for COVID-19 treatment and post-exposure prophylaxis), there is another excellent option. If a CLL / SLL patient tests positive for COVID-19, has mild to moderate disease, and is in the first few days post-diagnosis, then remdesivir is a good option. Remdesivir is an already fully FDA-approved antiviral medication that can be given as a short IV infusion in the outpatient setting daily for three consecutive days to lower the risk of progression to severe disease by 87%. This was published in the prestigious New England Journal of Medicine: Early Remdesivir to Prevent Progression to Severe COVID-19 in Outpatients. Though not studied against Omicron, as is also the case with the two largely unavailable oral antivirals, there is no reason to believe it won’t work on all variants.

The best plan is not to get COVID-19, but IV remdesivir may be the best and only option for combatting Omicron. At least for the next several weeks until we have better access to both Evusheld for prevention as well as access to any new and effective treatments.

As with all things COVID-19, this is an ever-changing story.

Stay strong. We are all in this together.

Brian Koffman, MDCM (retired) MS Ed (he, him, his)
Co-Founder, Executive VP and Chief Medical Officer
CLL Society, Inc.

CLL Society - COVID-19

When appropriate, the CLL Society will be posting updates and background information on the present Coronavirus pandemic focusing on reliable primary sources of information and avoiding most of the news that is not directly from reliable medical experts or government and world health agencies.