Update Alert: Remdesivir for Adults With COVID-19
Authors: Anjum S. Kaka, Roderick MacDonald, Eric J. Linskens, Timothy J. Wilt
Journal: Annals of Internal Medicine (2021)

Letters15 June 2021Update Alert: Remdesivir for Adults With COVID-19FREEAnjum S. Kaka, MD, Roderick MacDonald, MS, Eric J. Linskens, BS, Timothy J. Wilt, MD, MPHAnjum S. Kaka, MDMinneapolis VA Health Care System and University of Minnesota School of Medicine, Minneapolis, MinnesotaSearch for more papers by this author, Roderick MacDonald, MSMinneapolis VA Health Care System, Minneapolis, MinnesotaSearch for more papers by this author, Eric J. Linskens, BSSearch for more papers by this author, Timothy J. Wilt, MD, MPHMinneapolis VA Health Care System and University of Minnesota School of Medicine, Minneapolis, MinnesotaSearch for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/L21-0375 SectionsSupplemental MaterialAboutVisual AbstractPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail This is the third update for our living, rapid review on remdesivir for adults with COVID-19 (1). Our first update, which included studies published through 7 December 2020, led to a major update (Supplement Figure 1) (2). Our second update found no new evidence (3). This third quarterly update, done using the same search strategies as the original review (1), identified 707 citations between 9 February and 10 May 2021. One new randomized controlled trial was eligible for inclusion (Supplement Figure 2) (4).The last major update included 5 trials for any disease severity. On the basis of the results of 4 trials, a 10-day course of remdesivir probably results in little to no difference in mortality but probably reduces serious adverse events and may reduce time to recovery in hospitalized patients (5–8). Two trials found that a 10-day course was not more effective than a 5-day course for moderate and severe disease (5, 9). One trial with low risk of bias (5) found that a 5-day course of remdesivir may result in a small mortality reduction in moderate disease.In this update, one small randomized controlled trial with high risk of bias (n = 82) (4) (Supplement Table 1) involving adults hospitalized with severe COVID-19 found that remdesivir for 5 days, compared with standard of care, in a per protocol analysis, resulted in a numerically higher, but not statistically significantly different, mortality at days 12 through 24 (14.7% [5 of 34] vs. 8.3% [3 of 36]; absolute risk difference, 6.4% [95% CI, −8.6% to 21.3%]) and subsequent need for invasive ventilation between days 12 and 24 (11.8% [4 of 34] vs. 5.6% [2 of 36]; absolute risk difference, 6.2% [CI, −7.0% to 19.4%]). There were no differences in frequency of nausea or vomiting, elevated liver enzymes, or creatinine level. Patients in the remdesivir and standard-of-care groups had an “equal time to recovery between 10 and 20 days” (no numerical data reported). Our analyses of all randomized patients provided similar mortality results.Given the study's high risk of bias, our original conclusions about certainty and strength of evidence of remdesivir for adults with COVID-19 remain unchanged (Supplement Tables 2 and 3).References1. Wilt TJ, Kaka AS, MacDonald R, et al. Remdesivir for adults with COVID-19: a living systematic review for American College of Physicians practice points. Ann Intern Med. 2021;174:209-220. [PMID: 33017170] doi:10.7326/M20-5752 LinkGoogle Scholar2. 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;174:663-672. [PMID: 33560863] doi:10.7326/M20-8148 LinkGoogle Scholar3. Kaka A, MacDonald R, Greer N, et al. Surveillance update–02/08/21. Ann Intern Med. 10 February 2021. Accessed at https://www.acpjournals.org/doi/10.7326/M20-8148 on 8 June 2021. Google Scholar4. Mahajan L, Singh AP. Clinical outcomes of using remdesivir in patients with moderate to severe COVID-19: a prospective randomised study. Indian J Anaesth. 2021;65:S41-S46. [PMID: 33814589] doi:10.4103/ija.IJA_149_21 CrossrefMedlineGoogle Scholar5. Spinner CD, Gottlieb RL, Criner GJ, et al; GS-US-540-5774 Investigators. Effect of remdesivir vs standard care on clinical status at 11 days in patients with moderate COVID-19: a randomized clinical trial. JAMA. 2020;324:1048-1057. [PMID: 32821939] doi:10.1001/jama.2020.16349 CrossrefMedlineGoogle Scholar6. Beigel JH, Tomashek KM, Dodd LE, et al; ACTT-1 Study Group Members. Remdesivir for the treatment of Covid-19—final report. N Engl J Med. 2020;383:1813-1826. [PMID: 32445440] doi:10.1056/NEJMoa2007764 CrossrefMedlineGoogle Scholar7. Pan H, Peto R, Henao-Restrepo A, et al; WHO Solidarity Trial Consortium. Repurposed antiviral drugs for Covid-19—interim WHO Solidarity trial results. N Engl J Med. 2021;384:497-511. [PMID: 33264556] doi:10.1056/NEJMoa2023184 CrossrefMedlineGoogle Scholar8. Wang Y, Zhang D, Du G, et al. Remdesivir in adults with severe COVID-19: a randomised, double-blind, placebo-controlled, multicentre trial. Lancet. 2020;395:1569-1578. [PMID: 32423584] doi:10.1016/S0140-6736(20)31022-9 CrossrefMedlineGoogle Scholar9. Goldman JD, Lye DCB, Hui DS, et al; GS-US-540-5773 Investigators. Remdesivir for 5 or 10 days in patients with severe Covid-19. N Engl J Med. 2020;383:1827-1837. [PMID: 32459919] doi:10.1056/NEJMoa2015301 CrossrefMedlineGoogle Scholar Comments 0 Comments Sign In to Submit A Comment Author, Article, and Disclosure InformationAuthors: Anjum S. Kaka, MD; Roderick MacDonald, MS; Eric J. Linskens, BS; Timothy J. Wilt, MD, MPHAffiliations: Minneapolis VA Health Care System and University of Minnesota School of Medicine, Minneapolis, MinnesotaMinneapolis VA Health Care System, Minneapolis, MinnesotaMinneapolis VA Health Care System and University of Minnesota School of Medicine, Minneapolis, MinnesotaDisclaimer: The materials presented here solely represent the views of the authors and do not necessarily represent those of the U.S. Department of Veterans Affairs or the U.S. government.Financial Support: The original review was funded by the Department of Veterans Affairs, Office of Research and Development, Health Services Research and Development Service, Evidence Synthesis Program.Disclosures: Disclosures can be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=L21-0375.Corresponding Author: Roderick MacDonald, MS, Minneapolis VA Health Care System, One Veterans Drive, Minneapolis, MN 55417; e-mail, roderick.macdonald@va.gov.This article was published at Annals.org on 15 June 2021. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetailsSee AlsoRemdesivir for Adults With COVID-19 Timothy J. Wilt , Anjum S. Kaka , Roderick MacDonald , Nancy Greer , Adam Obley , and Wei Duan-Porter Major Update: Remdesivir for Adults With COVID-19 Anjum S. Kaka , Roderick MacDonald , Nancy Greer , Kathryn Vela , Wei Duan-Porter , Adam Obley , and Timothy J. Wilt Update Alert: Should Remdesivir Be Used for the Treatment of Patients With COVID-19? Rapid, Living Practice Points From the American College of Physicians (Version 2) Amir Qaseem , Jennifer Yost , Itziar Etxeandia-Ikobaltzeta , George M. Abraham , Janet A. Jokela , Matthew C. Miller , Mary Ann Forciea , and Linda L. Humphrey , for the Scientific Medical Policy Committee of the American College of Physicians*Update Alert 2: Remdesivir for Adults With COVID-19 Anjum S. Kaka , Roderick MacDonald , Eric J. Linskens and Timothy J. Wilt Major Update 2: Remdesivir for Adults With COVID-19: A Living Systematic Review and Meta-analysis for the American College of Physicians Practice Points Anjum S. Kaka , Roderick MacDonald , Eric J. Linskens , Lisa Langsetmo , Kathryn Vela , Wei Duan-Porter , and Timothy J. Wilt Metrics Cited byMajor Update 2: Remdesivir for Adults With COVID-19: A Living Systematic Review and Meta-analysis for the American College of Physicians Practice PointsAnjum S. Kaka, MD, Roderick MacDonald, MS, Eric J. Linskens, BS, Lisa Langsetmo, PhD, Kathryn Vela, MLIS, Wei Duan-Porter, MD, PhD, and Timothy J. Wilt, MD, MPHShould Remdesivir Be Used for the Treatment of Patients With COVID-19? Rapid, Living Practice Points From the American College of Physicians (Version 2, Update Alert 3)Amir Qaseem, MD, PhD, MHA, Jennifer Yost, PhD, RN, Itziar Etxeandia-Ikobaltzeta, PharmD, PhD, George M. Abraham, MD, MPH, Janet A. Jokela, MD, MPH, Mary Ann Forciea, MD, Matthew C. Miller, MD, Linda L. Humphrey, MD, MPH, for the Scientific Medical Policy Committee of the American College of Physicians*Estimation Model for Healthcare Costs and Intensive Care Units Access for Covid-19 Patients and Evaluation of the Effects of Remdesivir in the Portuguese Context: Hypothetical StudyUpdate Alert 2: Remdesivir for Adults With COVID-19Anjum S. Kaka, MD, Roderick MacDonald, MS, Eric J. Linskens, BS and Timothy J. Wilt, MD, MPHUpdate Alert 2: Should Remdesivir Be Used for the Treatment of Patients With COVID-19? Rapid, Living Practice Points From the American College of Physicians (Version 2)Amir Qaseem, MD, PhD, MHA, Jennifer Yost, PhD, RN, Itziar Etxeandia-Ikobaltzeta, PharmD, PhD, George M. Abraham, MD, MPH, Janet A. Jokela, MD, MPH, Matthew C. Miller, MD, Mary Ann Forciea, MD and Linda L. Humphrey, MD, MPH, for the Scientific Medical Policy Committee of the American College of Physicians* July 2021Volume 174, Issue 7 Page: W65 Keywords COVID-19 Disclosure Health services research Liver Mortality Nausea Research design Serious adverse events Veteran care Vomiting ePublished: 15 June 2021 Issue Published: July 2021 PDF downloadLoading ...