Relevant papers
| Author, date, country | Patient group | Study type | Outcomes measured | Results found | Study weaknesses |
| S Antinori et al, Italy1 2020 | 35 patients over 18 years of age with confirmed COVID-19 infection requiring mechanical ventilation or had SpO2 ≤94% on room air or national early warning score of ≥4 18 patients were recruited in the intensive care unit and 17 in the infectious disease ward Patients were allowed to continue their other treatments (including hydroxychloroquine) but had to discontinue other antivirals 37% discontinued the intervention because of side effects | Open-label prospective study | Hospitalisation status as primary outcome Side effects as secondary outcomes | At day 28, 82.3% of patients on the infectious disease ward were discharged and 5.9% had died 33.3% were discharged from intensive care and 44.4% had died with 16.7% still mechanically ventilated Hepatotoxicity in 42.8% as most common side effect | Presence of confounding factors No control group Open-label compassionate single-centre trial Small size cohort |
| J Grein et al., 20202 | 53 patients with confirmed COVID-19 infection with SpO2 ≤94% or who received oxygen support received at least one dose of remdesivir as intervention | Multicentre prospective study | Improvement in oxygen support, hospital discharge and adverse events | At day 28, the cumulative incidence of improvement was 84% (95% CI 70 to 99) Overall mortality was 0.56 per 100 hospitalisations (95% CI 0.14 to 0.97) 23% of patients developed severe adverse events | No clearly pre-defined endpoints Open-label compassionate trial Small size cohort No control group Short duration of follow-up |
| J Goldman et al., USA 20203 | Patients with COVID-19 infection with SpO2 ≤94% or receiving supplemental oxygen therapy and radiological evidence of pneumonia 200 patients received remdesivir for 5 days and 197 for 10 days Patients requiring ventilatory support at baseline were excluded | Randomised, open-label multicentre trial | Clinical status at day 14 based on an ordinal scale Adverse events as secondary outcomes | After adjustment for clinical status, both patient groups had similar outcome at day 14 (p=0.14) 70% of patients in the 5-day group experienced adverse events vs 74% in the 10-day group | No placebo control group Results cannot be extrapolated to critically ill patients |
| J Beigel et al., 20204 | 1063 patients with COVID-19 infection and confirmed lower respiratory tract involvement 541 randomised to remdesivir and 522 to placebo Patients were allowed to receive other supportive treatments | Multicentre double-blind, randomised placebo-controlled trial | Time to recovery Serious adverse events | The intervention group had a shorter recovery time (median days 11 vs 15 in the placebo group) Rate ratio 1.32 (95% CI 1.12 to 1.55, p<0.001) Mortality in the intervention group was 7.1% vs 11.9% HR 0.70 (95% CI 0.47 to 1.04) Serious adverse events occurred in 21.1% in the intervention group vs 27% in the placebo one | Potential confounders Unclear what was defined as lower respiratory involvement Full statistical analysis still ongoing (preliminary report) |
| Wang et al., China 20205 | 237 patients with COVID-19 pneumonia confirmed with imaging with SpO2 ≤94% or PaO2/FiO2 ≤300 mm Hg 158 assigned to intervention and 79 to placebo (2:1 randomisation) Patients allowed concomitant use of ani-retrovirals, corticosteroids and interferons | Multicentre double-blind, randomised placebo-controlled trial | Clinical improvement Adverse events | Intervention was not found to be liked to improvement (median 21 days vs 23 in placebo) HR 1.23 (95% CI 0.87 to 1.75) 28-day mortality 14% vs 13%, difference 1.1% (95% CI −8.1 to 10.3) 66% patients in the intervention group displayed adverse events vs 64% in the control group | Potential confounders Intervention seems to have been started relatively late Underpowered as the study was terminated early |