key: cord-0699045-wr6x57nz
authors: Wu, Peter E.; Morris, Andrew M.
title: Remdesivir for patients with COVID-19
date: 2021-01-25
journal: CMAJ
DOI: 10.1503/cmaj.202505
sha: 3b8f38febd0c40dfa317be7c8326839f8b7ad968
doc_id: 699045
cord_uid: wr6x57nz

nan

The ACTT-1 found that median time to clinical improvement was shortened from 15 to 10 days, with the greatest improvement seen in patients requiring low-flow oxygen. The trial did not find a difference in mortality (hazard ratio 0.73, 95% confidence interval [CI] 0.52-1.03), although it was not powered to do so. 1 Solidarity failed to show a mortality benefit (rate ratio 0.95, 95% CI 0.81-1.11) and also did not show a benefit in the prespecified secondary outcomes of ventilation or time to discharge. 5

Subgroup analyses from ACTT-1 and Solidarity showed that remdesivir conferred no benefit in patients who were intubated or on extracorporeal membrane oxygenation. 1, 5 Although less certain, there did not appear to be significant benefit for patients on high-flow oxygen. 1,5

Patients with elevated levels of liver enzymes or a glomerular filtration rate less than 30 mL/min were excluded from the published trials. 1, 2, 4, 5 Drug-induced liver injuries have been reported, 6 

Peter E. Wu MD MSc, Andrew M. Morris MD SM n Cite as: CMAJ 2021 January 25;193:E125. doi: 10.1503/cmaj.202505; early-released January 6, 2021

ACTT-1 Study Group Members. Remdesivir for the treatment of COVID-19: final report

Remdesivir in adults with severe COVID-19: a randomised, double-blind, placebo-controlled, multicentre trial

Available: www.canada.ca/en/ health-canada/services/drugs-health-products/covid19-industry/ drugs-vaccines-treatments/remdesivir-update.html (accessed

GS-US-540-5774 Investigators. Effect of remdesivir vs standard care on clinical status at 11 days in patients with moderate COVID-19: a randomized clinical trial

Repurposed antiviral drugs for COVID-19: interim WHO Solidarity Trial results

Acetylcysteine for the treatment of suspected remdesivir-associated acute liver failure in COVID-19: a case series

Competing interests: Peter Wu is a member of and Andrew Morris chairs the Ontario COVID-19 Clinical Practice Guideline working group, a volunteer provincial working group aimed at providing consensus-based, evidence-informed treatment guidelines for COVID-19. No other competing interests were declared. This article has been peer reviewed.