Saskatchewan. changes COVID-19 treatment arsenal as virus evolves

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Saskatchewan is rolling out a new outpatient program after a new iteration of COVID-19 made an older treatment less effective.

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Months of fear came to life when Scott Robertson’s COVID-19 test came back positive.

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“For a while it was like a kick in the head,” Robertson said.

He received a double lung transplant in September after a battle with chronic obstructive pulmonary disease (COPD). His health condition caused the virus to hit him like a train.

“I had trouble walking. It was almost like I still had COPD. I was wheezing while trying to climb the stairs. I was tired all the time,” he said.

That’s when Robertson became the first patient in a treatment program that Saskatchewan hopes to keep its most vulnerable COVID-19 patients out of hospital.

Within days, he was sitting in an impromptu clinic at Prairieland Park in Saskatoon, in a room with a patterned gray carpet lit by bright fluorescent bulbs, receiving the first of three intravenous drops of remdesivir, an antiviral drug the province hopes to be able to fill a gap in its therapeutic arsenal.

“The important thing is to target people who we think will need it,” said infectious disease physician Dr Satchan Takaya. “Those who may end up in hospital – those are the ones we try to catch for treatment.”

Remdesivir is an antiviral drug that Saskatchewan recently began using as a treatment for outpatient COVID-19 patients.
Remdesivir is an antiviral drug that Saskatchewan recently began using as a treatment for outpatient COVID-19 patients. Photo courtesy Saskatchewan Health Au /Courtesy of Saskatchewan Health Authority

Similar clinics previously offered a monoclonal antibody called sotrovimab, which targeted the virus that causes COVID-19 in the same way as “homemade” antibodies. Saskatchewan quietly suspended the use of this therapeutic weeks ago after evidence accumulated that BA.2, a new iteration of the Omicron variant that has become the predominant strain of the virus in Saskatchewan, was there. more resistant.

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That left a “hole” in the toolbox for patients who couldn’t receive Paxlovid, an oral antiviral drug that can’t be combined with a long list of common drugs, Takaya said.

“It was difficult to know what to do at first,” said Dr. Stephen Lee, who is leading the province’s therapeutic response to COVID-19.

They landed on remdesivir, a federal antiviral regulator approved in 2020 to treat COVID-19 in hospital settings. Health Canada decided the drug could be offered in an outpatient model on April 21, the same day Saskatchewan launched its clinic. Lee said the drugs are about as good, although they’ve never been compared in a direct trial.

Remdesivir is given intravenously over three two-hour treatment sessions. After his first, Robertson said he remembered feeling as “sick as a dog,” but by the third round he felt greatly improved. He said he would recommend the treatment to anyone in his place.

“We thought for sure it was a hospital stay or potentially a death sentence,” his wife Robin said.

Takaya said demand for treatments in Saskatchewan is growing, likely due to rising infections and heightened awareness of drug availability — but relatively few COVID-19 patients will get them.

Saskatchewan reserves remdesivir and Paxlovid for patients who are unvaccinated, elderly, immunocompromised or a combination of the three, and only in the early phase of the disease. The Department of Health says it has received about 4,800 courses of the oral antiviral Paxlovid from federal stock since late January, but has only dispensed 281, or about half a percent of its stock.

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Lee said that wasn’t a bad thing. He says the response to COVID-19 is like a huge puzzle where therapeutics is a key piece, but not a “quick fix”. Vaccination remains the main bulwark against infection, he said.

“It’s not that we don’t want to offer it to everyone. If you are triple vaccinated, young, healthy… your chances of landing in the hospital are very low.

Lee said he contracted COVID-19 himself in February, but would not have taken Paxlovid if it had been offered to him because the potential side effects could outweigh the benefits.

“It’s good medicine, but it’s good medicine for the right person,” he said.

Takaya said he doesn’t think the program will end anytime soon, given the virus’ propensity to evolve and evade some of the protection provided by vaccines.

“In many people’s minds, COVID is over. But this part of COVID is just getting started, I think. We’re here for the long haul.

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