Background A 43 year old patient previously treated for re-activation of Ebola Virus Disease1 presented to hospital with a twin pregnancy. As a conservative precaution, Remdesivir was obtained for potential use in the mother and the neonates.
Method All literature was reviewed on the drug in trial and restricted license, along with drugs previously administered in this patient. The recommendation was made to consider Remdesivir and Favipiravir. The patient had received Remdesivir with probable benefit in the past. As the drug is unlicensed, the clinical team from Gilead, California were closely involved. Details of drug dosage and side effects were provided following a non-disclosure agreement. Preparations were made for an import licence following approval by NHS Greater Glasgow and Clyde health board and the Medicines and Healthcare products Regulatory Agency to import the product from California into the UK.
Temperature monitored storage was arranged in advance and the drug appropriately stored. The pharmacy manual was supplied by Gilead and worksheets were prepared in advance.2 A small team of out of hours aseptic pharmacists and technicians were briefed in order to facilitate immediate supply if required. Based on published data, there were no known drug interactions and no contra-indications to breastfeeding.3
Outcome In the weeks leading up to the delivery the infectious diseases pharmacist, aseptic lead pharmacist and neonatal pharmacist were on call for that period to then cascade requirements down to other pharmacy staff, if required out of hours. The twins were delivered safely with no issues for the neonates or the mother.
Jacobs M, et al. Late Ebola virus relapse causing meningoencephalitis: a case report, Lancet 2016;388:498–503
GS-5734 for Injection Pharmacy Manual rev 2.1, Gilead Sciences Inc, Foster City CA94404
WHO R&D Blueprint – Ad-hoc Expert Consultation on clinical trials for Ebola Therapeutics, http://www.who.int/ebola/drc-2018/summaries-of-evidence-experimental-therapeutics.pdf?ua=1 accessed 20th May 2019
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