ACP recommends remdesivir for moderate, severe COVID-19
In new Rapid Living Practice Points published in the Annals of Internal Medicine, the ACP announced that current evidence suggests there is a net benefit associated with the use of remdesivir in patients with COVID-19.
“With remdesivir there is evidence of benefit with shorter duration treatment for patients with both moderate or severe COVID-19, which is positive news in the search for treatments of patients with COVID-19,” ACP President Jacqueline W. Fincher, MD, said in a press release.
The practice points, developed by the ACP’s Scientific Medical Policy Committee (SMPC), were based on a systematic review conducted by the U.S. Department of Veteran Affairs.
In the paper, SMPC members said that research comparing 5-day and 10-day treatment with remdesivir showed that the 5-day treatment period may slightly reduce mortality and result in slightly increased clinical improvement compared with the 10-day treatment. They also found that 5-day treatment with remdesivir may result in fewer adverse events than the 10-day treatment but may not lead to a decrease in serious adverse events.
SMPC members did not identify an effect on other critical outcomes — including recovery and hospitalization time — and important outcomes — including time to recovery, invasive ventilation, ECMO and adverse events that were not serious — in either 5-day or 10-day treatment periods in moderate COVID-19.
Although more research is needed, SMPC members said that evidence suggests a 5-day treatment period is as effective as a 10-day treatment period in patients with severe COVID-19 who do not require ventilation or ECMO at baseline.
However, they also found evidence that patients placed on mechanical ventilation or ECMO at day 5 may benefit from extending the remdesivir treatment period to 10 days compared with discontinuing treatment after 5 days.
Based on these findings, the ACP recommends:
- 5-day treatment with remdesivir in patients with moderate COVID-19;
- 5-day treatment with remdesivir in patients with severe COVID-19 who do not require ventilation or EMCO; and
- consider extending remdesivir treatment to 10 days in patients with severe COVID-19 who require ventilation or ECMO during initial 5-day treatment period.
The ACP noted that there are currently numerous studies on remdesivir in COVID-19 that are planned or ongoing, so the practice points will be reviewed continually, with updates planned every 2 months through December 2021. However, the SMPC will assess the priority of the topic and the state of evidence continuously and may choose to modify the 2-month update interval.
As there are still significant research gaps surrounding remdesivir treatment in COVID-19, Fincher said “additional rigorous studies are needed to assess the benefits and harms of using remdesivir to treat patients with COVID-19.”
References:
Qaseem A, et al. Ann Intern Med. 2020;doi:10.7326/M20-5831.