COVID-19: the evidence to date for remdesivir

  • Wilt TJ & al.
  • Ann Intern Med
  • 5 Oct 2020

  • curated by Jenny Blair, MD
  • Clinical Essentials
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Takeaway

  • A small evidence base suggests benefits for remdesivir in the treatment of COVID-19.

Why this matters

  • Remdesivir remains investigational, with limited-use authorizations hurried through in spring.
  • Trial enrollment continues.

Key results

  • Remdesivir vs placebo (2 studies):
    • Mortality: absolute risk difference (ARD), −4% to 1% (low certainty).
    • Recovery: ARD, 7%-10% (moderate certainty).
    • Serious adverse events (SAEs): ARD, −8% to −6% (moderate certainty).
  • Remdesivir, 5 vs 10 days (2 studies): 
    • Mortality: reduced (low certainty), except among patients requiring invasive ventilation or extracorporeal membrane oxygenation who may do better with a 10-day course.
    • Recovery or clinical improvement: improved (low certainty).
    • Time to recovery: reduced. 
    • SAEs: reduced.
    • Length of stay (LOS): no effect.

Study design

  • A systematic review of 4 randomized trials, January-August 2020, assessing remdesivir treatment in adult patients with COVID-19. 
  • Outcomes: death, recovery, hospital LOS, SAE.
  • Funding: US Department of Veterans Affairs.

Limitations

  • 2 trials were open label, 1 was a preliminary report.
  • Most patients were white men around age 60 years.
  • Adults with pregnancy or with severe kidney or liver disease were excluded.
  • Insufficient data for meta-analysis.