COVID-19 Evidence Alerts
from McMaster PLUSTM

Current best evidence for clinical care (more info)

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Treatment Kaka AS, MacDonald R, Greer N, et al. Major Update: Remdesivir for Adults With COVID-19 : A Living Systematic Review and Meta-analysis for the American College of Physicians Practice Points. Ann Intern Med. 2021 Feb 9. doi: 10.7326/M20-8148.
Abstract

BACKGROUND: Remdesivir is being studied and used for treatment of coronavirus disease 2019 (COVID-19).

PURPOSE: To update a previous review of remdesivir for adults with COVID-19, including new meta-analyses of patients with COVID-19 of any severity compared with control.

DATA SOURCES: Several sources from 1 January 2020 through 7 December 2020.

STUDY SELECTION: English-language, randomized controlled trials (RCTs) of remdesivir for COVID-19. New evidence is incorporated by using living review methods.

DATA EXTRACTION: 1 reviewer abstracted data; a second reviewer verified the data. The Cochrane Risk of Bias Tool and GRADE (Grading of Recommendations Assessment, Development and Evaluation) method were used.

DATA SYNTHESIS: The update includes 5 RCTs, incorporating data from a new large RCT and the final results of a previous RCT. Compared with control, a 10-day course of remdesivir probably results in little to no reduction in mortality (risk ratio [RR], 0.93 [95% CI, 0.82 to 1.06]; 4 RCTs) but may result in a small reduction in the proportion of patients receiving mechanical ventilation (RR, 0.71 [CI, 0.56 to 0.90]; 3 RCTs). Remdesivir probably results in a moderate increase in the percentage of patients who recovered and a moderate decrease in serious adverse events and may result in a large reduction in time to recovery. Effect on hospital length of stay or percentage remaining hospitalized is mixed. Compared with a 10-day course for those not requiring ventilation at baseline, a 5-day course may reduce mortality, the need for ventilation, and serious adverse events while increasing the percentage of patients who recovered or clinically improved.

LIMITATION: Summarizing findings was challenging because of varying disease severity definitions and outcomes.

CONCLUSION: In hospitalized adults with COVID-19, remdesivir probably results in little to no mortality difference but probably improves the percentage recovered and reduces serious harms and may result in a small reduction in the proportion receiving ventilation. For patients not receiving ventilation, a 5-day course may provide greater benefits and fewer harms with lower drug costs than a 10-day course.

PRIMARY FUNDING SOURCE: U.S. Department of Veterans Affairs.

Ratings
Discipline / Specialty Area Score
Infectious Disease
Hospital Doctor/Hospitalists
Internal Medicine
Intensivist/Critical Care
Respirology/Pulmonology
Comments from MORE raters

Infectious Disease rater

This is a nice update summarizing the evidence for a possible small benefit for remdesivir treatment.

Internal Medicine rater

This is already standard practice at our institution, so this information isn't going to change anything. What would be more helpful is to know how and when to give steroids. This seems to vary quite a lot from place to place, with some reserving it for inpatient admissions, others giving it to outpatients, etc.

Internal Medicine rater

A current (through Dec 2020) summary of what we know about using remdesivir to treat adults with Covid-19. Little effect on mortality but it does seem to hasten recovery. New to me: for patients not needing a ventilator, a 5-day course is superior to 10 days.

Respirology/Pulmonology rater

Review of several remdesivir trials for Covid-19 suggests reduction in need for mechanical ventilation and less severe disease. A 5-day course is as efficacious as 10 days with fewer side effects. Confirms the benefit of the drug in treating Covid-19