Recommendation for Remdesivir for the Treatment of Severe COVID-19 Remains Weak

In an article in The BMJ, a panel of international experts presented recommendations regarding the use of remdesivir in patients with severe coronavirus disease 2019 (COVID-19), despite little evidence to support such a decision.

The experts in the panel explained that they would strongly support the decision to continue enrolling patients in ongoing clinical trials studying remdesivir’s efficacy in patients with severe COVID-19.

This advice was presented as a part of The BMJ's Rapid Recommendations initiative, which was developed to present rapid and trustworthy guidelines based on new research to support providers’ decisions with patients in their clinical practices.

Remdesivir has received global attention as a treatment for patients with severe COVID-19 and has been used in practices for such treatment.

Due to the low level of certainty in the evidence of remdesivir’s efficacy in such treatment, a living systematic review was also published in The BMJ prior to the expert panel’s recommendations. The review compared potential treatments for COVID-19.

The results of the review demonstrated that although remdesivir can be an effective treatment for reducing recovery time in patients with severe COVID-19, the certainty of the evidence for most comparisons was very low due to the lack of blinding and serious imprecision in the studies that made this assessment.

Additionally, the authors of the review noted that remdesivir probably has no significant effect on the necessity for mechanical ventilation or on the length of the hospital stay. Any efficacy ascertained may also be due to the small cohort size and significant limitations of the studies presenting the drug’s efficacy.

After reviewing this evidence, the international panel of experts continued to assert that most patients with severe COVID-19 would likely still choose treatment with remdesivir due to its potential to reduce treatment time.

For this reason, the experts explained that continued recruitment of patients for further trials testing remdesivir was necessary. Additionally, the experts suggested that these trials should focus on optimal dose and duration of therapy, as well as whether there are any specific groups of patients who would most benefit from treatment with the drug.

However, the authors of the review noted that caution should be given to the use of remdesivir due to the cost of the drug in relation to the uncertain evidence supporting its use. They explained that remdesivir is a relatively costly, intravenous drug that could potentially divert funds, time, attention, and workforce away from more potentially effective treatments.

REFERENCE

Experts make weak recommendation for remdesivir in severe COVID-19. The BMJ; July 30, 2020. eurekalert.org/pub_releases/2020-07/b-emw073020.php. Accessed August 18, 2020.