Remdesivir May Lower Mortality in Patients Hospitalized With COVID-19, Not on Oxygen Therapy

Investigators have observed that remdesivir may be effective for patients who are hospitalized with severe COVID-19 infection but who are not on oxygen therapy, which they published in a paper in The Lancet Respiratory Medicine. The findings are in accordance with World Health Organization guidelines, which do not recommend remdesivir for patients with critical cases of COVID-19.¹

Remdesivir is an antiviral that gained notoriety as one of the first treatments for COVID-19. It was approved in the United States in 2020, followed by European approval. Numerous clinical studies have examined its efficacy at preventing mortality among patients hospitalized with COVID-19, but the results are contrary and unconclusive, according to the current study. Further, current data are not consistent about which patient populations benefit from remdesivir.¹

Investigators out of the University of Basel and the University Hospital of Basel in Switzerland conducted a meta-analysis of 8 randomized clinical trials to learn about possible patient groups who benefitted from remdesivir. The team, led by clinical epidemiologist Matthias Briel, looked at data from 10,000 unvaccinated patients across 40 countries who were hospitalized and treated for COVID-19. The team evaluated the benefits and possible adverse events (AEs) of remdesivir across various sub-groups.¹

The findings showed that remdesivir decreased the risk of mortality in patients who were not given oxygen therapy. Additionally, remdesivir appeared to increase survival benefits in patients who received conventional oxygen support. Both subgroups experienced a 2% decrease in mortality events over a 4-week observation period, which translates to 20 fewer deaths per 1000 patients.¹

Not all patient groups experienced the same level of benefits from remdesivir, and “the benefit to patients with intensive ventilation support remains unclear,” said Alain Amstutz, first author of the study, in the press release. However, investigators note that there are limited data about patients who needed heavy support with ventilation.¹

Further, evidence is lacking regarding remdesivir and its survival benefits across age groups, comorbidities, level of inflammation markers, or its effects on early hospital discharge. The AE profile of remdesivir also appears to be minimal, according to the study authors.¹

“Fortunately, we found that remdesivir does not lead to more serious unwanted side effects than standard treatment,” said Benjamin Speich, co-first author of the study, in the press release.¹

Remdesivir is a nucleotide prodrug that stops a virus from spreading by destroying its RNA transcription.² It is currently recommended for clinical use in high-risk, non-hospitalized patients with mild to moderate COVID-19, as well as patients with or without immunodialators and certain hospitalized patients, according to Therapeutic Management of Hospitalized Adults With COVID-19.²

Moreover, questions remain about the effects of remdesivir in those who received a COVID-19 vaccine and patients who have recovered from prior COVID-19 infection. Investigators are not yet aware about how cost-effective remdesivir is, which they said should be addressed in future studies.¹

Reference

1. University of Basel. When is remdesivir effective for COVID-19? News Release. February 21, 2023. Accessed on February 22, 2023. https://www.eurekalert.org/news-releases/980261
2. NIH. Remdesivir. COVID-19 Treatment Guidelines. December 1, 2022. Accessed February 22, 2023. https://www.covid19treatmentguidelines.nih.gov/therapies/antivirals-including-antibody-products/remdesivir/