St. David’s South Austin Medical Center is one of the hospitals around the country that’s testing merimepodib, a COVID-19 antiviral medication in the trial stage.
The hospital was asked to enroll 10 to 15 patients in the randomized trial by ViralClear Pharmaceuticals Inc. and has already done so, said Dr. Matthew Robinson, medical director of infectious disease at St. David's South Austin. The hospital will continue enrolling patients until it is told the study is no longer accepting participants.
St. David’s South Austin already has been treating patients with another antiviral, remdesivir, as well as a steroid, dexamethasone, and convalescent plasma from people who had the virus and recovered.
Initial studies in laboratories have shown that using remdesivir and merimepodib together increases the effectiveness of treatment versus using merimepodib alone, Robinson said. Under the study in which St. David’s is participating, patients are given remdesivir and then blindly assigned to also get either a placebo or merimepodib.
Robinson added that "it would be difficult to withhold what has been established as a standard of care from patients" as another reason that remdesivir is used in the study, too.
Antivirals are most effective when given in the disease’s early stages, which has been a challenge with this study and COVID-19 research in general. Antivirals stop the virus from replicating rather than treating its symptoms. In the case of merimepodib, it inhibits the pathway that produces the building block of RNA that the virus needs to replicate itself. Steroids work differently; they treat the inflammatory response that patients are experiencing.
COVID-19 has three different stages: the viral phase, the pulmonary phase (which is marked by coughing or difficulty breathing) and the hyperinflammatory stage, when the body’s immune system is attacking the organs. Most patients are coming into the hospital seven to 10 days after first experiencing symptoms, either in the pulmonary or hyperinflammatory stage, Robinson said.
"In the perfect world, I would like to start an antiviral on day one," he said, "but that’s not very realistic."
Some of these drugs are given through an IV and some people won’t ever develop symptoms and won’t need the antivirals to recover from the virus.
"We’d be treating a whole host of patients that did not require it," he said.
Because this is a blind study — doctors don’t know which patient got which set of medications — it might be weeks to months before the data are available to know whether this antiviral is effective, Robinson said, but he believes it will be fast-tracked, as most of the COVID-19 drug studies have been.
He’s seen strides made in treatment since March, when Travis County saw its first confirmed cases of COVID-19, to where we are today. As more treatments have become known, Robinson said, he has seen a decrease in the mortality rate of people being treated for COVID-19 at his hospital. That is what other doctors and the Centers for Disease Control and Prevention are finding throughout the country.
"Perhaps the most frustrating aspect is there are some patients that no matter what we do, it doesn’t seem to alter their course," he said.
Robinson encouraged people to come into the hospital earlier, when they feel as if they can’t catch their breath.
"Don’t try to be a hero and ride it out at home," he said, but he added that you should not come in if you have mild symptoms, in order to avoid overwhelming a hospital that has been challenged by the number of patients.
Travis County has seen a surge of cases since June and now has an average of 65 new hospitalizations a day.
"Fortunately, we have not reached a point that we have exceeded our capacity to treat these patients," Robinson said. "We’re constantly evaluating that. Hopefully, we don’t reach that point."
While the ages of patients are spread out, Robinson sees a disproportionate number of Hispanic people needing to be hospitalized, which Austin Public Health also has noted (in addition to disproportionately high rates for African Americans).
As much as doctors now know about the virus, Robinson said, "this is a unique illness. It is completely unlike anything else we’ve ever experienced."