Trump receiving remdesivir antiviral drug as part of experimental treatment

President Donald Trump is receiving an experimental antiviral for Covid-19 called remdesivir as he remains hospitalized at Walter Reed National Military Medical Center in Bethesda, Maryland. The drug is being given as part of a double-barreled treatment plan that includes an antibody cocktail meant to give the president’s immune system a boost to fight off the coronavirus.

The president was given the first dose of remdesivir Friday evening and will be on a five-day course of the IV drug, his physician, Dr. Sean Conley, said during a news conference Saturday.

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Remdesivir, manufactured by Gilead Sciences, works by lowering the amount of virus in the body. Clinical trial data published in May found that the drug reduced patients’ length of hospital stay by about four days, from 15 days to a median of 11 days.

In July, additional data showed remdesivir may reduce deaths.

“It’s not really a treatment in the sense that it’ll cure people,” Dr. Irwin Redlener, director of the Pandemic Resource and Response Initiative at Columbia University’s National Center for Disaster Preparedness, said Saturday on MSNBC. “It will just hopefully reduce the fatality rate and reduce the course of the illness.”

Remdesivir is generally used for patients who need supplemental oxygen, although Conley said Trump did not need help breathing Saturday morning. When pressed during the briefing about whether the president had ever received supplemental oxygen, Conley persistently said the president had not received oxygen on Thursday or while at Walter Reed on Friday and Saturday.

It was unclear whether the president needed oxygen at another time.

Conley told reporters Saturday that Trump is doing “very well” but the coming days will be critical to the president’s recovery.

“With the known course of the illness, day seven to 10, we get really concerned about the inflammatory phase, phase two,” Conley said. “Given that we provided some of these advanced therapies so early in the course, a little bit earlier than most of the patients we know and follow, it’s hard to tell where he is on that course.”

Not the usual care

In addition to remdesivir, the president has received a combination antibody treatment. It’s a cocktail of two monoclonal antibodies. Antibodies act by recognizing specific germs — in this case, SARS-CoV-2, the virus that causes Covid-19 — and harnessing the immune system to fight them off.

“We are maximizing all aspects of his care, attacking this virus with a multi-pronged approach,” Conley said. “He’s the president, and I didn’t want to hold anything back. If there was any possibility that it would add value to his care and expedite his return, I wanted to take it.”

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The double-barreled approach is not usual care for patients in the president’s condition, especially since both treatments are still in clinical trial.

But in theory, the two would work “synergistically,” said Dr. Hugh Cassiere, director of critical care services for Sandra Atlas Bass Heart Hospital at North Shore University Hospital, part of Northwell Health, on Long Island, New York.

“The remdesivir is supposed to stop viral replication, but if there is some virus that does replicate, the monoclonal antibodies would mop that up,” Cassiere said, adding that both drugs appear to be safe.

It is unclear when or even if the Food and Drug Administration will ultimately approve either treatment. The FDA issued an emergency use authorization for remdesivir, and the monoclonal antibodies were given under what’s known as compassionate use.

Given what’s known so far about both treatments, Cassiere predicted they will someday become standard.

The president, he said, “is getting a standard of care months before anyone else.”

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