COVID-19 research briefs: remdesivir shortens recovery time

Daily POEMs

Published: 2020-06-14 © 2020 John Wiley & Sons, Inc.

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Clinical question
Can remdesivir improve outcomes in people with COVID-19?

Bottom line
Remdesivir shortens recovery time in hospitalized patients with COVID-19 and lower respiratory tract infections (ACTT-1). (LOE = 4)

Reference
Beigel JH, Tomashek KM, Dodd LE, et al. Remdesivir for the Treatment of Covid-19 - Preliminary Report [published online ahead of print, 2020 May 22]. N Engl J Med. 2020;10.1056/NEJMoa2007764. doi:10.1056/NEJMoa2007764.

Study design: Randomized controlled trial (double-blinded)

Setting: Inpatient (ward only)

Synopsis
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%).

Henry C. Barry, MD, MS
Professor
Michigan State University
East Lansing, MI

Copyright © 2020 John Wiley & Sons, Inc.