Remdesivir, COVID-19, and Pregnancy

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Are there any medications that pregnant women can take if they become infected with COVID-19? As of mid-April, 2020, the answer is maybe. In the weeks before April, there was a lot of buzz about the drugs hydroxychloroquine and chloroquine, but a new drug you may be hearing more about is an antiviral drug called remdesivir. In a trial of this drug reported by the New England Journal of Medicine, two-thirds of severely ill COVID-19 patients improved after receiving intravenous doses of remdesivir.

Antibiotics do not kill viruses like COVID-19. Researchers are looking for other drugs that can. Remdesivir is an experimental drug, so it is not officially approved for anyone, let alone pregnant women. However, the maker of this drug has made it available for use by pregnant women and children who are severely ill with COVID-19 under a compassionate use program that bypasses the usual FDA approval process.

Remdesivir was developed in 2014 to treat the Ebola virus. It works by interfering with the genetic code of a virus and preventing it from reproducing, called replication. In laboratory studies, this drug can successfully prevent replication of Ebola, COVID-19, and other coronaviruses. We should know more about how it works in real-life humans when we get the results of ongoing studies.

Hope for Remdesivir

In the New England Journal of Medicine report, there were 53 patients with COVID-19 that were treated. They all had COVID-19 that was severe enough to interfere with breathing. The trial was done on 22 patients from the US, 22 from Europe, and 9 from Japan. These patients received 10 days of intravenous remdesivir. Two-thirds of the patients improved, including 17 patients who were getting assisted breathing from a respirator. One-third of patients did not improve.

Because remdesivir has now been shown to be successful in the lab and in an early trial in hospitalized patients with COVID-19, it could be a game changer if further studies confirm this early trial. As of now, there are no drugs that are approved to treat this virus. Treatment is basically isolation, rest, support, oxygen, and assisted breathing if needed.

We do not know if remdesivir will have any adverse effects in pregnancy. In China, a combination antiviral drugs called Lopinavir/Ritonavir was used routinely for patients with COVID-19, including during pregnancy. This drug combination is commonly used to treat HIV/AIDS and is considered relatively safe during pregnancy. Antivirals are also routinely used in pregnant women to treat or prevent flu.

Caution for Remdesivir

There are several reasons to be cautious. Remdesivir was developed to treat Ebola because it worked well in the lab, but when it was used for real people, the results were disappointing. Although the new study was done in people, the numbers were small. There was also no control group. Without comparing similar patients in which one group received remdesivir and the other group received a placebo (placebo-controlled), there is no way to know if the patients that improved would have improved on their own without the drug.

For now, pregnant women severely ill with COVID-19 may take remdesivir under the compassionate care provision. Ongoing studies, which are larger and are placebo-controlled will tell us if remdesivir may be the first approved drug for COVID-19.

Christopher Iliades
Dr. Chris Iliades is a medical doctor with 20 years of experience in clinical medicine and clinical research. Chris has been a full time medical writer and journalist since 2004. His byline appears in over 1,000 articles online including EverydayHealth, The Clinical Advisor, and Healthgrades. He has also written for print media including Cruising World Magazine, MD News, and The Johns Hopkins Children's Center Magazine. Chris lives with his wife and close to his three children and four grandchildren in the Boston area.

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