A short-cut review of the available medical literature was carried out to establish whether remdesivir was an effective treatment for patients with confirmed COVID-19 infection. After abstract review, five papers were found to answer this clinical question using the detailed search strategy. The author, date and country of publication, patient group studied, study type, relevant outcomes, results and study weaknesses of these papers are tabulated. It is concluded that despite some recent promising studies, further well-designed and larger trials are needed to answer this specific question.
- emergency care systems
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A 55-year-old man presents to your ED with shortness of breath and fever for a few days. A nasopharyngeal swab confirms a COVID-19 infection. As an evidence-based doctor, you have been pretty active at following emerging potential treatments and wonder if treatment with remdesivir would improve your patient’s clinical course.
In [adult patients with confirmed COVID-19 infection] does treatment with [remdesivir] improve [clinical outcome]?
OVID MEDLINE 1946 to June 19 2020
[Coronavirus.exp OR coronavirus.mp OR COVID-19.mp OR sars-cov-2.mp OR SARS$.mp OR coroa$.mp] AND [remdesivir.mp OR GS-5734.mp]
Search limited to English language and humans
75 Papers found of which three were deemed relevant
Embase 1996 to 2020 week 25
[Coronavirus.mp OR coronavirinae.exp OR COVID-19.mp OR SARS coronavirus.exp OR sars-cov-2.mp OR corona$.mp OR SARS$.mp] AND [remdesivir.mp OR remdesivir.exp OR GS-5734.mp]
Search limited to English Language and humans
422 papers found of which five were deemed relevant
Table 1 below summarises the relevant included studies after duplicates were excluded.
Although several approved drugs have shown some antiviral activity against SARS-CoV-2 in in vitro settings, there are no antiviral therapies of proven benefit in treating patients infected with this emerging infection. Remdesivir is an adenosine prodrug that inhibits all human and animal coronaviruses in vitro so it was felt it would show some promising results in human trials.
This is a rapidly evolving picture with ongoing clinical trials at time of publication.
Several smaller trials1–3 have been published to date, but two larger trials however merit further attention and scrutiny.
Wang et al 4 were unable to demonstrate any statistically significant clinical benefits for remdesivir but failed to complete full recruitment as set out at start of the trial due to the end of the outbreak. At the time of review and publication, we only had access to the preliminary report for the trial by Beigel et al,5 the largest trial to date. The authors’ conclusions were that remdesivir was of benefit for in-patients requiring supplemental oxygen but also cautioned that in view of the high mortality rate despite its use, remdesivir was unlikely to be sufficient alone.
Clinical bottom line
Further larger-scale and well-designed clinical trials are needed to establish the exact role of remdesivir in the treatment of COVID-19 infections.