Question clinique
Can remdesivir improve outcomes in people with COVID-19?
L’Essentiel
Remdesivir shortens recovery time in hospitalized patients with COVID-19 and lower respiratory tract infections (ACTT-1). 4
Référence
Plan de l'etude: Randomized controlled trial (double-blinded)
Financement:
Cadre: Inpatient (ward only)
Sommaire
Research Brief #33: This preliminary report of a multicenter, multinational randomized trial caught a lot of news attention (see COVID-19 Research Brief from April 30) and it has now been published! The study, the Adaptive Covid-19 Treatment Trial (ACTT-1), took place in 60 different sites in the US, Germany, Denmark, the United Kingdom, Greece, Korea, Mexico, Spain, and Japan. The researchers randomized 1063 patients hospitalized with COVID-19 and evidence of lower respiratory tract involvement to receive remdesivir (n=538; 200 mg IV on day 1 and then 100 mg IV daily for up to 10 days or hospital discharge) or matching placebo infusion (n=521). There was a little controversy about this study because in mid-April, the primary endpoint was switched from mortality to time to recover. Time to recovery was significantly faster in the remdesivir-treated group than in those receiving placebo (11 vs 15 days, p < 0.001). There was also a trend toward lower 14-day mortality in the remdesivir group (7.1% vs 11.9%), but this was not statistically significant. If the mortality difference were significant, this would translate to a number needed to treat of 21. Projecting statistically, it is likely the study would have needed to continue for 1-2 weeks to accrue enough patients and events for the mortality data to become statistically significant. The rate of serious adverse events in the remdesivir-treated patients was slightly lower (21.1%) than in those receiving placebo (27.0%).
Reviewer
Henry C. Barry, MD, MS
Professor
Michigan State University
East Lansing, MI
Commentaires
Remdesivir
As an antiviral I would not expect great results after the inflammatory phase has begun.
Currently not available to our province.
I wish we had data in its use in high risk groups, started during purely viral phase (prehospital) . Agree cost and availability would be an issue .
We are concluding this drug has limited benefit but are studying the wrong population