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COVID-19: Remdesivir for Hospitalized Adults - A Living Rapid Review

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COVID-19: Remdesivir for Hospitalized Adults – A Living Rapid Review

Prepared by:
Evidence Synthesis Program (ESP) Center
Minneapolis VA Health Care System
Minneapolis, MN
Timothy J. Wilt, MD, MPH, Director

Recommended citation:
Wilt TJ, Kaka AS, MacDonald R, et al. COVID-19: Remdesivir for Adults – A Living Review. Updated August 2021. Washington, DC: Evidence Synthesis Program, Health Services Research and Development Service, Office of Research and Development, Department of Veterans Affairs. VA ESP Project #09-009; Aug 2021.



Download PDF: Report, Supplemental Materials

Takeaway/Bottom Line

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. Effect on hospital length of stay or percentage remaining hospitalized is mixed. 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.

Context

Individuals hospitalized with COVID-19 infection are at risk of prolonged hospitalization, hypoxic respiratory failure, end-organ damage, needing advanced airway support, and dying. Remdesivir inhibits viral RNA polymerases, is administered intravenously, and has in vitro activity against SARS-CoV-2. Randomized trials of remdesivir have been completed. Remdesivir is approved for treatment of adults hospitalized with COVID-19. We conducted a living rapid review to evaluate the effectiveness and harms of remdesivir for treatment of adults hospitalized for COVID-19.

Key Findings

Five RCTs (and one small add-on sub-study), evaluated remdesivir versus placebo/standard care and 2 RCTs evaluated 10-day versus 5-day remdesivir course. Compared with control, a 10-day remdesivir course probably results in little to no mortality reduction (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, need for ventilation, and serious adverse events while increasing the percentage of patients recovered or clinically improved.

See also

Kaka AS, MacDonald R, Greer N, Vela K, Duan-Porter W, Obley A, and Wilt TJ. Major Update: Remdesivir for Adults With COVID-19 - A Living Systematic Review and Meta-analysis for the American College of Physicians Practice Points. Annals of Internal Medicine. 2021;174(5):663-672. DOI: https://doi.org/10.7326/M20-8148.


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