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MultiCare doctors help with COVID-19 treatment trials – and are optimistic about early results

UPDATED: Thu., April 30, 2020

A group of MultiCare doctors are contributing to the global effort to find a treatment for COVID-19 at Spokane hospitals, and they’re feeling good about what they’re finding.

The MultiCare physicians are participating in clinical trials for two different potential COVID-19 treatments: remdesivir and convalescent plasma.

The former is an antiviral drug that early results suggest can speed the recovery of patients infected with COVID-19.

The latter involves using plasma donated by those who have recovered from COVID-19 to treat people currently suffering from the virus.

MultiCare decided to participate in clinical trials with Gilead Sciences Inc. – the makers of remdesivir – after small-scale trials in China had positive results. The first U.S. patient treated with this antiviral drug was from Snohomish County and was also believed at the time to be among the country’s first infected patients. That patient’s recovery was detailed in the New England Journal of Medicine.

Dr. Vinay Malhotra, principal investigator in the Gilead trial, said MultiCare has since treated 53 patients, including some from Spokane, with the drug at MultiCare Deaconess Hospital and MultiCare Valley Hospital.

Of those patients, MultiCare has discharged 28. Three have died.

“I think it’s one of the tools” that can be used to fight COVID-19, Malhotra said. “If given early to the patient who comes in with this disease, it has a clear chance that it helps them recover, and also recover faster.”

Once the patient has gotten to the point where they are going into respiratory failure or multiple organ failure, Malhotra said, “I think you need a multiple approach at that time, because there’s a lot of things going on with the patient at the same time, not just the virus.”

The ongoing trial looks at whether five-day courses of remdesivir, which works by preventing viral RNA from replicating, have the same efficacy as 10-day courses. So far, the results are positive. All patients enrolled in the trial received the treatment; there was no placebo group.

This is separate from a trial sponsored by the National Institute of Allergy and Infectious Diseases, which has involved 1,063 patients. The trial had a placebo group, and neither the doctors nor the patients knew who was receiving treatment. The study said those who received the drug had a 31% faster recovery time, and an 8% mortality rate, versus 11.6% in the placebo group. Those participating in the trial were severe cases.

“There is still more work to do and remdesivir has not been approved, but all of us at Gilead are humbled by what these promising results might mean for patients,” Daniel O’Day, Gilead Sciences chairman and CEO, said in an open letter about the NIAID findings.

While the U.S. Food and Drug Administration has not approved remdesivir to treat any illness, it has been used to treat Ebola and SARS, which belong to the filovirus family that also includes COVID-19.

Since April 18, MultiCare has also been working with the Mayo Clinic to conduct clinical trials of plasma convalesence.

In this treatment, patients are infused with plasma taken from people who have recovered from the coronavirus. The idea is that those who have recovered developed the antibodies to fight the virus and that these antibodies can help those who have been infected.

Malhotra and Scott Meehan, a pulmonary and critical care physician withthe MultiCare system in Tacoma, both said the plasma treatment is promising.

People who have recovered from the coronavirus are encouraged to donate their plasma at a Vitalant plasma center. Anyone can make an appointment through the website, but potential donors must have positive test results to donate.

Each donation can help two to four patients, and seven participants in the trial are waiting for plasma, said Meehan.

Though this method is relatively new for fighting coronavirus, plasma treatments are tried and true, and were even used in the 1918 flu.

“This is kind of a (time-tested) treatment that has helped,” Meehan said. “What we don’t know is who are the right people to give it to and at what point. We’re giving it currently to our absolute sickest people. That’s who we wanted to reach first.”

As with the remdesivir trial that MultiCare is participating in, there are no placebo treatments.

“You look at the risks and the benefits anytime we’re giving anybody any kind of treatment,” Meehan said. “There are no additional risks. This is the same risk profile as if someone was getting a transfusion of plasma for some other reason.”

Meehan encouraged anyone who has recovered from coronavirus to donate plasma.

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