Remdesivir in COVID-19: shortened recovery time, no significant mortality benefit

  • Beigel JH & al.
  • N Engl J Med
  • 22 May 2020

  • curated by Liz Scherer
  • Clinical Essentials
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Takeaway

  • Preliminary findings from the first placebo-controlled trial of remdesivir for COVID-19 show shortened recovery time in hospitalized adults.
  • Mortality was numerically lower with remdesivir but did not reach significance.

Why this matters

  • Remdesivir may offer benefit in terms of shortened recovery time.
  • Mortality benefit, if any, is unclear.

Study design

  • Double-blind, randomized, placebo-controlled analysis of intravenous remdesivir (200-mg loading dose+100 mg/day up to 9 days) in 1059 patients (538 remdesivir, 521 placebo) with laboratory-confirmed COVID-19.
  • Researchers used an 8-category ordinal scale to track recovery from baseline; a low score indicates better status.
  • Funding: NIH.

Key results

  • Mean age, 58.9 years; 64.3% male.
  • 27.0% had 1 comorbidity; 52.1% had ≥2 comorbidities.
  • Time to recovery: 11 days with remdesivir vs 15 days with placebo (P<.001>
  • Rate ratios for recovery (95% CIs) were better with lower baseline ordinal scale scores:
    • Baseline, 4 (n=127): 1.38 (0.94-2.03).
    • Baseline, 5 (n=421): 1.47 (1.17-1.84).
    • Baseline, 6 (n=197): 1.20 (0.79-1.81).
    • Baseline, 7 (receiving mechanical ventilation or extracorporeal membrane oxygenation, n=272): 0.95 (0.64-1.42).
  • Rate ratio for recovery for adjusted treatment effect (n=1017): 1.31 (1.12-1.54).
  • Mortality (HRs; 95% CIs) at day 14:
    • Overall: 0.70 (0.47-1.04).
    • Adjusted, remdesivir: 7.1% (5.0%-9.9%).
    • Adjusted, placebo: 11.9% (9.2%-15.4%).

Limitations

  • Protocol changes.
  • Remote follow-up.