El tratamiento del COVID 19: evidencias y uso del Remdesivir

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Por: Mg. Edgar Cabrera
edgarcabrera875@gmail.com

La pandemia del COVID 19 está generando información epidemiológica y clínica en una escala sin precedentes para una enfermedad de reciente aparición, se han realizado estudios y ensayos de distintos medicamentos, los ya conocidos y nuevos, con el fin de tratar la afección que afecta a toda la salud mundial.  

El desafío es conciliar la urgencia de actuar con la generación de nuevos conocimientos en base a lo que ya se cuenta, cabe destacar que en esta era donde la información es más rápida, los medios de comunicación son un arma de doble filo, donde facilitan compartir los conocimientos existentes, sino que, también actúan como medios de presión por parte de la población para la pronta resolución de lo que está afectando a todos.

 Es importante recordar que en las ciencias de la salud es erróneo asumir que la eventual curación se debe a un fármaco en específico y que un mal desenlace se atribuye a la enfermedad, además de que, actualmente no existe un tratamiento efectivo bien validado para el COVID-19.(1)

Siendo el SARS-CoV-2 un virus y causante de esta enfermedad emergente, se han postulado diferentes fármacos antivíricos en el tratamiento de esta neumonía vírica por SARS-CoV-2, fundamentándose en su actividad frente a otras infecciones causadas por otros virus diferentes y en experiencias clínica extraídas de estudios observacionales. Con los ensayos realizados, se ha visto la efectividad del Remdesivir para el tratamiento de los pacientes afectados por este mal. La Organización Mundial de la Salud (OMS) expone que el Remdesivir no registra impacto alguno en la mortalidad de pacientes con COVID-19, sin embargo, si muestra reducción de la estancia hospitalaria.(2)

El Remdesivir (RDV) es un profármaco que interrumpe la replicación viral al inhibir la enzima ARN polimerasa del virus, no es un fármaco creado recientemente, por el contrario, ya lleva unos años en el mercado y ha sido desarrollado inicialmente como terapia frente al virus del ébola, que no debe administrarse sin indicaciones médicas, es decir evitar la automedicación.

Está indicado como tratamiento precoz en los primeros días de la enfermedad, administrándose por cinco días, puede ser en pacientes con oxigenoterapia convencional, aunque no se han reportado grandes beneficios en pacientes que cuentan con mayor soporte respiratorio (cánula de alto flujo o asistencia mecánica respiratoria).

Viene en presentación de frasco ampolla de 100mg para reconstituir con solución fisiológica al 0,9% y posteriormente administrarse vía IV. mediante perfus (volutrol) y no como inyección IM. Por goteo lento, en 60 a 120 minutos, el medicamento diluido es estable durante 4 horas a temperatura ambiente (entre 20 °C y 25 °C) o durante 24 horas refrigerado (entre 2 °C y 8 °C).

Durante la administración, debe observarse reacciones de hipersensibilidad que incluyen reacciones anafilácticas y relacionadas con la perfusión durante y después de la administración de Remdesivir, que pueden incluir hipotensión, hipertensión, taquicardia, bradicardia, hipoxia, pirexia, disnea, sibilancia, angioedema, erupción, náuseas, vómitos, diaforesis y escalofrío, en caso de presentarse estos signos y síntomas durante la administración, hay que suspender inmediatamente la administración de remdesivir e iniciar el tratamiento adecuado.(3)

Como es un medicamento de ensayo, no se recomienda el uso durante el embarazo o la lactancia. En el caso de los niños, el Ministerio de Salud recomienda administrar a mayores de 12 años. (4)

Como el medicamento está aún bajo rigurosas investigaciones, es importante mencionar que puede presentarse nuevas formas de administración, así como, pueden aparecer nuevos o mejores fármacos que sean efectivos en el tratamiento y recuperación de los pacientes que estén afectados por el COVID 19.

Es importante destacar que el Ministerio de Salud Pública y Bienestar Social luego de un profundo análisis de expertos ha determinado incluir este fármaco con un protocolo establecido para el tratamiento.

Referencias:

1.           Dorati CM, Mordujovich Buschiazzo P, Marin G, Buschiazzo HO, Buschiazzo Cloroquina HO. Remdesivir para el tratamiento de infección por COVID-19 Informe de Revisión Rápida Otros documentos de CUFAR relacionados con este informe [Internet]. La Plata; 2020 May [cited 2021 Jun 22]. Available from: http://www.med.unlp.edu.ar/index.php/news/43-

2.           Saiz Fernández LC. Remdesivir como potencial terapia frente al COVID-19 [Internet]. 2020 Apr [cited 2021 Jun 22]. Available from: https://es.cochrane.org/sites/es.cochrane.org/files/public/uploads/COVID-19/cochrane_navarra_covid-19_remdesivir.pdf

3.           CHMP. ANEXO I FICHA TÉCNICA O RESUMEN DE LAS CARACTERÍSTICAS DEL PRODUCTO.

4.           Remdesivir: su eficacia para el tratamiento del COVID-19 continúa en estudio – Ministerio de Salud Publica y Bienestar Social [Internet]. 2020 [cited 2021 Jun 22]. Available from: https://www.mspbs.gov.py/portal/21999/remdesivir-su-eficacia-para-el-tratamiento-del-covid-19-continua-en-estudio.html

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