Evidence Shows Net benefit of Remdesivir for patients with COVID-19, says ACP

Remdesivir is a broad-spectrum antiviral agent administered intravenously. Currently the effectiveness of remdesivir is being tested as a treatment for patients infected with SARS-CoV-2 (COVID-19) and has been authorized for emergency use for the treatment of COVID-19 in the US by the Food and Drug Administration and in other countries.

The ACP Practice Points found that evidence points toward a net benefit for using remdesivir in patients with COVID-19 and recommend:

Use remdesivir for 5 days as a treatment for patients with moderate COVID-19.

Use remdesivir for 5 days as a treatment for patients with severe COVID-19 who do not require mechanical ventilation or extracorporeal membrane oxygenation (ECMO).

Consider extending the use of remdesivir to 10 days in patients with severe COVID-19 requiring mechanical ventilation or ECMO within a 5-day course.

ACP's Living Practice Points show that evidence comparing 5-day vs. 10-day course indicated that a 5-day course of remdesivir may slightly reduce mortality and may slightly increase clinical improvement compared with a 10-day course. Evidence for potential harms showed that a 5-day course may result in slightly fewer adverse events (any) compared with a 10-day course, although the shorter course may not result in fewer serious adverse events.

There is no evidence for any effect on other critical outcomes (recovery, hospital length of stay) or important outcomes (time to recovery, time to clinical improvement, invasive mechanical ventilation/ECMO, non-serious adverse events) with either course in patients with moderate COVID-19. There is no evidence about whether outcomes vary by symptom duration in patients with moderate COVID-19.

While more evidence is needed and several studies are planned, there is evidence that a 5-day course is as effective as a 10-day course of remdesivir with fewer potential harms in patients with severe COVID-19 not requiring mechanical ventilation or ECMO at baseline or a 10-day course in patients with severe COVID-19 who progress to needing mechanical ventilation or ECMO within a 5-day course. ACP's Practice Points suggest that future studies should assess treatment duration by symptom, severity, and evaluate clinical outcomes such as respiratory failure.

ACP's Practice Points are developed by ACP's Scientific Medical Policy Committee and provide advice to improve the health of individuals and populations and promote high-value care based on the best available evidence derived from the assessment of scientific work (e.g. clinical guidelines, systematic reviews, individual studies). ACP Practice Points aim to address the value of screening and diagnostic tests and therapeutic interventions for various diseases and consider known determinants of health, including but not limited to genetic variability, environment, and lifestyle.

The ACP Practice Points will be maintained as a "living" document and ACP's Scientific Medical Policy Committee will monitor emerging evidence to determine its impact on the main findings and conclusions, and issue updates as needed.