COVID-19: Remdesivir for Hospitalized Adults - A Living Rapid Review
Evidence Synthesis Program (ESP) Center
Minneapolis VA Health Care System
Timothy J. Wilt, MD, MPH, Director
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.
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.
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.
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.