“Plan is to produce remdesivir for 2 million patients by end of year”, says scientist behind COVID-19 fighting drug

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The European Commission has signed a contract with Gilead Sciences, the company behind remdesivir, that will make the drug available to around 500,000 patients.The drug will certainly be necessary if vaccination is not widespread, says Doctor Tomáš Cihlář, who is Gilead Sciences’ vicepresident for virology and the leader of the research team that developed redemsivir. He spoke to Czech Radio earlier this week in an exclusive interview.

Remdesivir has proven itself helpful in speeding up the recovery of patients suffering from the coronavirus and reducing COVID-19 mortality. It appeared in the spotlight again earlier this week, when it was revealed that remdesivir was one of the cocktail of drugs administered to US President Donald J. Trump, after he was hospitalised.

Thus far remdesivir has been available in limited numbers and only used in the most serious cases. A five day treatment package, administered intravenaly, currently costs 2,340 USD, and is therefore inaccessible to large segments of a country’s population.

However, it may soon become much more readily available to patients in the European Union after the European Commission signed a contract with US pharma company Gilead Sciences for the delivery of 500,000 units of remdesivir.

“The plan is to produce enough remdesivirfor 2 million patients by the end of the year, with production increasing at the start of next year.”

The man who lead the team that developed remdesivir is the Czech doctor Tomáš Cihlář, who works at Gilead Sciences as the vicepresident and head of its department of biology. He explained what the current level of production is worldwide.

“First of all, there is production going on at Gilead, where the plan is to produce enough remdesivir for 2 million patients by the end of the year, with production increasing at the start of next year. Such a level of production should be sufficient for covering the needs of the United States, Europe and many developed states.

“At the same time we are trying to find mechanisms that would allow us to distribute remdesivir into other countries, particularly developing states. In order to reach this target, we have teamed up with several companies in South-East Asia, which have the infrastructure to produce generic pharmaceuticals that cover the needs of developing countries. We are hoping that these two approaches will ensure that there is enough redemsivir.”

Remdesivir, photo: archive of General University Hospital in Prague

It is as of yet unclear how much remdesivir treatment will actually cost in the many public, or semi-public health care systems in Europe. In the Czech Republic for example, the Ministry of Health negotiates the price of a drug directly with the company. However, Dr. Cihlář believes it will be lower than the current price in the United States.

Aside from making remdesivir more accessible, Gilead Sciences is also working on a version that would be administered via inhalation. Research in this area seems very promising, the Czech scientist says.

“We have managed to quickly find a formula that enables one to take remdesivir by inhaling it. Pre-clinical research showed that it has roughly the same effect as when received intravenaly.

“In the period around the end of July and the beginning of September we also phase one of clinical studies on healthy patients. I have received information that phase-two is currently being conducted on those patients that have been diagnosed with the coronavirus but are not yet in hospital.”

“Combination therapy is clearly the right direction for hospitalized patients.”

Dr. Cihlář says that the definite level of effectiveness of the inhalatory version of remdesivir should be established within the next few months. He believes that this will enable patients to use the drug immediately after being diagnosed and therefore prevent the disease from evolving into a later, more serious stage that would necesitate hospitalisation, something that is considerably more difficult when the drug has to be administered intravenaly.

At first, remdesivir was only tested as a form of monotherapy. However, a study conducted by the American National Institute of Health made significant advances in terms of discovering how redemsivir can be combined with other drugs to make the healing process more effective.

Further research took place by combining remdesivir with a drug called baricitinib, normally used to help cure reumathoid arthritis, Dr. Cihlář says.

“It is a so-called protein-kinase inhibitor, which suppresses the inflammatory response in the lungs. The substance is given in combination with remdesivir to hospitalized patients in the most severe cases. In these, the combination produced a disappearance of symptoms one day sooner than if remdesivir is administered by itself.

Illustrative photo: Governor Tom Wolf, Flickr, CC BY 2.0

“As a result, convalescence, the time when we see symptoms of the disease, is reduced by one day, so this is a very promising direction in regards to the treatment process - combining remdesivir with anti-inflamatory drugs.

“However, there are also other medicines that are being tested in combination with remdesivir. For example, neutralizing antibodies. Combination therapy is clearly the right direction for hospitalized patients.”

While remdesivir has proven it can be effective in treating patients infected with COVID-19, the distribution of an effective vaccine is decisive in geting the pandemic under control, says Dr. Cihlář.

“If the vaccine shows itself to be safe - the safety criterion is of primary importance - and effective, if it leads to the forming of antibodies among patients who receive it, we expect the vaccine will have two effects.

“First of all, it will stop the virus from spreading among the population. Second, the vaccine will limit the severity of the sickness among those patients whose immunity responce is less strong, if it does not outright stop it.

Illustrative photo: pearson0612, Pixabay / CC0

“That means COVID-19 would not be as serious an illness as it is today. This would in turn minimize the number of patients that need to be hospitalised and thus also affect the need for administering remdesivir intravenaly in hospitals.”

Nevertheless, even if a vaccine is made available, the Czech scientist says that the key factor will be the level of inoculation among the population. If not sufficiently high, there will still be patients that will require remdesivir.

For those patients the inhalatory form of remdesivir could be administered before they enter hospital. It could be used as a means of helping patients recover by themselves and easing the possible burden on the health care system, which would otherwise need to hospitalize them.