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 February 2022. 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; 2022.
A 10-day remdesivir course probably results in little to no mortality reduction. Remdesivir probably results in small reductions in proportion on mechanical ventilation but little to no difference in new ventilation needs. Remdesivir probably moderately increases percent recovered, may lead to small decreases in serious adverse events and large reductions in recovery time. For patients not receiving ventilation, a 5-day course may provide greater benefits, fewer harms and lower drug costs than a 10-day course.
Individuals with COVID-19 infection are at risk of hospitalization, respiratory failure, end-organ damage and death. Remdesivir is administered intravenously and has in vitro activity against SARS-CoV-2. Remdesivir is approved for most patients over age 12 hospitalized with COVID-19, and for certain non-hospitalized high-risk patients with mild-to-moderate disease. We conducted a living rapid review to evaluate the effectiveness and harms of remdesivir for treatment of adults for COVID-19. This is the final update.
Our final review update of 5 RCTs and 2 subtrials confirm a 10-day course of remdesivir probably results in little to no mortality reduction (5 RCTs). Remdesivir probably results in a moderate increase in the proportion of patients recovered (4 RCTs) and may reduce time to clinical improvement (2 RCTs) and hospital length of stay (4 RCTs). New RCTs lead to an updated conclusion that remdesivir probably results in small reductions in the proportion of patients receiving ventilation or extracorporeal membrane oxygenation (4 RCTs). New RCTs also alter harms conclusions—remdesivir, compared with control, may lead to a small reduction in serious adverse events but may lead to a small increase in any adverse event. 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.
Kaka A, MacDonald R, Linskens E, et al. Major Update 2: 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. Published online on March 1, 2022. DOI: 10.7326/M21-4784.