Should Remdesivir Be Used for the Treatment of Patients With COVID-19? Rapid, Living Practice Points From the American College of Physicians (Version 1)

Abstract

These rapid and living practice points from the American College of Physicians address the effectiveness and harms of remdesivir treatment in patients with COVID-19.

Figure.. Evidence description.

The evidence search and assessment were conducted by the U.S. Department of Veterans Affairs Evidence Synthesis Program, Minneapolis, Minnesota (14). Current search for evidence, completed on 3 June 2020, aimed to identify RCTs evaluating remdesivir for treatment of patients with COVID-19. COVID-19 = coronavirus disease 2019; ECMO = extracorporeal membrane oxygenation; RCT = randomized controlled trial. * Patients requiring mechanical ventilation or ECMO were excluded from 1 RCT (17); therefore, despite a few patients (3.3%) developing a requirement for invasive mechanical ventilation between screening and the beginning of the treatment, this study is analyzed as being representative of patients with severe disease not requiring mechanical ventilation or ECMO at baseline. † Within the evidence reviewed, severe COVID-19 is defined as hospitalized patients meeting 1 or more of the following criteria: radiographic infiltrates on imaging, an oxygen saturation level ≤94% on room air, tachypnea (respiratory rate >24 breaths per minute without supplemental oxygen), or need for supplemental oxygen or mechanical ventilation; moderate COVID-19 is defined as hospitalized patients with radiographic infiltrates and oxygen saturation greater than 94% on room air; and mild COVID-19 was not defined (14). ‡ Most (88.7%) of the participants enrolled in 1 RCT (16) had severe disease, so this study is analyzed as being representative of patients with severe disease.