Remdesivir and dexamethasone are among therapies used for inpatient care
UCLA Health patients hospitalized with COVID-19 have access to the most beneficial known treatments and a variety of cutting-edge experimental treatment trials.
For severe life-threatening infections, the antiviral remdesivir and the steroid dexamethasone are both used for inpatient treatment, said Otto Yang, MD, a professor in the division of infectious diseases at the David Geffen School of Medicine at UCLA. To date, these are the only known treatments that are widely accepted as being effective for patients who are seriously ill.
Dr. Yang, who has been conducting clinical trials of remdesivir, said since the start of the pandemic, treatment has improved based on growing knowledge that these agents are helpful.
“Certainly remdesivir is a big advance,” Yang said. “Steroids do appear to have an impact on reducing deaths. There have also been other general advances in terms of intensive care physicians having a better understanding of the disease and the management of it in terms of optimizing supportive care.”
Even before remdesivir received emergency approval by the Food and Drug Administration in May for severe cases, UCLA physicians were treating patients with remdesivir via a “compassionate use protocol” as early as March. Some UCLA Health coronavirus patients participated in a clinical trial led by Dr. Yang, which found that the drug shortened the recovery period for patients that survived the virus.
Remdesivir, which is given by infusion, is now widely available to UCLA patients.
“Generally, it does look like a lot of patients will turn around pretty well as long as they aren’t critically ill,” Dr. Yang said. “Fever will go away, oxygen requirements will stabilize or improve in a few days. Overall, it does look like it’s helping quite a bit.”
The original trial of remdesivir has continued in new phases, with the drug being combined with other agents. In his current clinical trial, Dr. Yang is studying the use of remdesivir in combination with interferon beta.
Dr. Yang said remdesivir’s benefits are most pronounced in patients with early severe disease as it works to stop the spread of the virus in the body.
Dexamethasone and overactive immune response
For patients who enter a second phase of illness during which their immune system overreacts in fighting the virus and causes damage to the lungs or other organs, a steroid such as dexamethasone works to reduce the immune response by acting on cells that cause inflammation.
Dexamethasone is among multiple steroids widely available for UCLA patients.
“Given too early, steroid treatments could be a problem,” Dr. Yang said. “You want the immune response to be active and clear the virus during the earlier phase of disease, and not tamp down the immune response until later when it is doing unnecessary damage.”
UCLA has been a leader in choosing and running clinical trials to discover the best treatments for COVID-19, and started testing remdesivir and other agents in March. UCLA Health’s COVID-19 patients have the advantage of access to many ongoing clinical trials, which may not only potentially benefit them, but improve treatment for all of society.
“We’ve been one of the most active places in terms of having clinical trials,” Dr. Yang said. “We’ve had a broad array of trials compared to most places.”
He urged patients to consider participating in trials when they qualify, because it has been the generosity of volunteers that have made advances in treating COVID-19 possible and will ensure continued development of the most effective treatments.
To learn more about COVID-19 clinical trials offered at UCLA, visit https://www.uclahealth.org/covid-19-clinical-trials
This article was written by Courtney Perkes.