PT  - JOURNAL ARTICLE
AU  - Karim Ali
AU  - Tanweer Azher
AU  - Mahin Baqi
AU  - Alexandra Binnie
AU  - Sergio Borgia
AU  - François M. Carrier
AU  - Yiorgos Alexandroa Cavayas
AU  - Nicolas Chagnon
AU  - Matthew P. Cheng
AU  - John Conly
AU  - Cecilia Costiniuk
AU  - Peter Daley
AU  - Nick Daneman
AU  - Josh Douglas
AU  - Catarina Downey
AU  - Erick Duan
AU  - Emmanuelle Duceppe
AU  - Madeleine Durand
AU  - Shane English
AU  - George Farjou
AU  - Evradiki Fera
AU  - Patricia Fontela
AU  - Rob Fowler
AU  - Michael Fralick
AU  - Anna Geagea
AU  - Jennifer Grant
AU  - Luke B. Harrison
AU  - Thomas Havey
AU  - Holly Hoang
AU  - Lauren E. Kelly
AU  - Yoav Keynan
AU  - Kosar Khwaja
AU  - Gail Klein
AU  - Marina Klein
AU  - Christophe Kolan
AU  - Nadine Kronfli
AU  - Francois Lamontagne
AU  - Rob Lau
AU  - Michael Fralick
AU  - Todd C. Lee
AU  - Nelson Lee
AU  - Rachel Lim
AU  - Sarah Longo
AU  - Alexandra Lostun
AU  - Erika MacIntyre
AU  - Isabelle Malhamé
AU  - Kathryn Mangof
AU  - Marlee McGuinty
AU  - Sonya Mergler
AU  - Matthew P. Munan
AU  - Srinivas Murthy
AU  - Conar O’Neil
AU  - Daniel Ovakim
AU  - Jesse Papenburg
AU  - Ken Parhar
AU  - Seema Nair Parvathy
AU  - Chandni Patel
AU  - Santiago Perez-Patrigeon
AU  - Ruxandra  Pinto
AU  - Subitha Rajakumaran
AU  - Asgar Rishu
AU  - Malaika Roba-Oshin
AU  - Moira Rushton
AU  - Mariam Saleem
AU  - Marina Salvadori
AU  - Kim Scherr
AU  - Kevin Schwartz
AU  - Makeda Semret
AU  - Michael Silverman
AU  - Ameeta Singh
AU  - Wendy Sligl
AU  - Stephanie Smith
AU  - Ranjani Somayaji
AU  - Darrell H.S.  Tan
AU  - Siobhan Tobin
AU  - Meaghan Todd
AU  - Tuong-Vi Tran
AU  - Alain Tremblay
AU  - Jennifer Tsang
AU  - Alexis Turgeon
AU  - Erik Vakil
AU  - Jason Weatherald
AU  - Cedric Yansouni
AU  - Ryan Zarychanski
AU  - Canadian Treatments for COVID-19 (CATCO)
ED  - ,
TI  - Remdesivir for the treatment of patients in hospital with COVID-19 in Canada: a randomized controlled trial
AID  - 10.1503/cmaj.211698
DP  - 2022 Feb 22
TA  - Canadian Medical Association Journal
PG  - E242--E251
VI  - 194
IP  - 7
4099  - http://www.cmaj.ca/content/194/7/E242.short
4100  - http://www.cmaj.ca/content/194/7/E242.full
SO  - CMAJ2022 Feb 22; 194
AB  - Background: The role of remdesivir in the treatment of patients in hospital with COVID-19 remains ill defined in a global context. The World Health Organization Solidarity randomized controlled trial (RCT) evaluated remdesivir in patients across many countries, with Canada enrolling patients using an expanded data collection format in the Canadian Treatments for COVID-19 (CATCO) trial. We report on the Canadian findings, with additional demographics, characteristics and clinical outcomes, to explore the potential for differential effects across different health care systems.Methods: We performed an open-label, pragmatic RCT in Canadian hospitals, in conjunction with the Solidarity trial. We randomized patients to 10 days of remdesivir (200 mg intravenously [IV] on day 0, followed by 100 mg IV daily), plus standard care, or standard care alone. The primary outcome was in-hospital mortality. Secondary outcomes included changes in clinical severity, oxygen- and ventilator-free days (at 28 d), incidence of new oxygen or mechanical ventilation use, duration of hospital stay, and adverse event rates. We performed a priori subgroup analyses according to duration of symptoms before enrolment, age, sex and severity of symptoms on presentation.Results: Across 52 Canadian hospitals, we randomized 1282 patients between Aug. 14, 2020, and Apr. 1, 2021, to remdesivir (n = 634) or standard of care (n = 648). Of these, 15 withdrew consent or were still in hospital, for a total sample of 1267 patients. Among patients assigned to receive remdesivir, in-hospital mortality was 18.7%, compared with 22.6% in the standard-of-care arm (relative risk [RR] 0.83 (95% confidence interval [CI] 0.67 to 1.03), and 60-day mortality was 24.8% and 28.2%, respectively (95% CI 0.72 to 1.07). For patients not mechanically ventilated at baseline, the need for mechanical ventilation was 8.0% in those assigned remdesivir, and 15.0% in those receiving standard of care (RR 0.53, 95% CI 0.38 to 0.75). Mean oxygen-free and ventilator-free days at day 28 were 15.9 (± standard deviation [SD] 10.5) and 21.4 (± SD 11.3) in those receiving remdesivir and 14.2 (± SD 11) and 19.5 (± SD 12.3) in those receiving standard of care (p = 0.006 and 0.007, respectively). There was no difference in safety events of new dialysis, change in creatinine, or new hepatic dysfunction between the 2 groups.Interpretation: Remdesivir, when compared with standard of care, has a modest but significant effect on outcomes important to patients and health systems, such as the need for mechanical ventilation. Trial registration: ClinicalTrials.gov, no. NCT04330690.