Remdesivir is an antiviral drug with activity against an array of RNA viruses
Remdesivir is an intravenous inhibitor of the viral RNA-dependent RNA polymerase with in vitro and in vivo activity against Middle East respiratory syndrome coronavirus, severe acute respiratory syndrome coronavirus 1 (SARS-CoV-1) and SARS-CoV-2.1–3 In Canada, it is authorized and available through Health Canada for patients (≥ 12 yr of age and weighing ≥ 40 kg) with coronavirus disease 2019 (COVID-19) who require oxygen.3
Remdesivir has been tested as a treatment for COVID-19 in 2 large clinical trials
There are 4 published randomized controlled trials (RCTs) that evaluated remdesivir for treatment of COVID-19.1,2,4,5 The 2 largest were the Adaptive Covid-19 Treatment Trial (ACTT-1), a placebo-controlled RCT involving 1062 patients,1 and Solidarity, an open-label RCT that compared treatment with remdesivir to standard of care in 6838 patients.5
Remdesivir may reduce recovery time but does not reduce mortality
The ACTT-1 found that median time to clinical improvement was shortened from 15 to 10 days, with the greatest improvement seen in patients requiring low-flow oxygen. The trial did not find a difference in mortality (hazard ratio 0.73, 95% confidence interval [CI] 0.52–1.03), although it was not powered to do so.1 Solidarity failed to show a mortality benefit (rate ratio 0.95, 95% CI 0.81–1.11) and also did not show a benefit in the prespecified secondary outcomes of ventilation or time to discharge.5
Remdesvir does not help critically ill patients
Subgroup analyses from ACTT-1 and Solidarity showed that remdesivir conferred no benefit in patients who were intubated or on extracorporeal membrane oxygenation.1,5 Although less certain, there did not appear to be significant benefit for patients on high-flow oxygen.1,5
Data for adverse events are limited but include hepatotoxicity and hypersensitivity reactions
Patients with elevated levels of liver enzymes or a glomerular filtration rate less than 30 mL/min were excluded from the published trials. 1,2,4,5 Drug-induced liver injuries have been reported,6 and anaphylaxis and infusion-related reactions can occur.1
Footnotes
Competing interests: Peter Wu is a member of and Andrew Morris chairs the Ontario COVID-19 Clinical Practice Guideline working group, a volunteer provincial working group aimed at providing consensus-based, evidence-informed treatment guidelines for COVID-19. No other competing interests were declared.
This article has been peer reviewed.
This is an Open Access article distributed in accordance with the terms of the Creative Commons Attribution (CC BY-NC-ND 4.0) license, which permits use, distribution and reproduction in any medium, provided that the original publication is properly cited, the use is noncommercial (i.e. research or educational use), and no modifications or adaptations are made. See: https://creativecommons.org/licenses/by-nc-nd/4.0/
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- Remdesivir may reduce recovery time but does not reduce mortality
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- Data for adverse events are limited but include hepatotoxicity and hypersensitivity reactions
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