1. Adults with severe COVID-19 treated with remdesivir had numerically faster time to clinical improvement compared to controls, but the difference was not statistically significant
Evidence Rating: 2 (Good)
Months into declaration of COVID-19 as a pandemic, there still remains to be an antiviral therapy of proven effectiveness in treating the disease. Remdesivir has been an agent receiving great media attention, as it has shown significant anti-viral activity against coronaviruses in vitro, including SARS-CoV-2, and isolated case studies have reported a benefit in using the drug for affected patients. To formally address its clinical efficacy, researchers recruited 237 patients with laboratory confirmed pneumonia from SARS-CoV-2 in a randomized, double-blind, placebo-controlled multicenter trial, randomly assigning patients in a 2:1 ratio to either receive remdesivir (200mg on day 1 IV followed by 100mg for 9 days following) or a placebo infusion. The primary endpoint of interest was clinical improvement up to day 28, defined as time from randomization to point of a decline in two levels on a six-point ordinal scale. Patients assigned to the treatment group had a numerically faster time to clinical improvement compared to the placebo group (median 18·0 days [IQR 12·0–28·0] vs 23·0 days [15·0–28·0]; HR 1·52 [0·95–2·43]), but results were not statistically significant. Likewise, rates of clinical improvement at days 14 and 28 were higher for the treatment group than placebo, but again, not statistically significant. Similar mortality rates were observed, and no significant differences were observed between the two groups in length of oxygen support, hospital stay, days from randomization to discharge, or time to clearance of virus. The treatment regimen was well tolerated by the remdesivir group, with similar rates of adverse events compared to the placebo recipients. Overall, while minute differences in clinical course were observed between the two groups, no significant clinical or antiviral effects were found at the treatment dose in this study. Future investigations may choose to use larger sample sizes or initiate treatment earlier in the disease course to continue informing the collective understanding of potential antiviral therapies for COVID-19.
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