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Remdesivir for Moderate COVID-19

Hana M. El Sahly, MD reviewing Spinner CD et al. JAMA 2020 Aug 21


A 5-day course of remdesivir was associated with a small, but significant, clinical improvement compared with standard care in patients with moderate COVID-19.

Remdesivir (RDV) was recently granted Emergency Use Authorization for patients with severe COVID-19 based on studies showing that time to recovery was decreased with RDV versus placebo (NEJM JW Infect Dis Aug 2020 and N Engl J Med 2020 May 22; [e-pub]) and that a 5-day course was equivalent to a 10-day course in patients who were hypoxic but not mechanically ventilated (NEJM JW Infect Dis Aug 2020 and N Engl J Med 2020 May 27; [e-pub]).

Now, investigators have conducted an industry-sponsored, open-label study to evaluate the efficacy of RDV in 584 patients with moderate disease, defined as those hospitalized with evidence of COVID-19 pneumonia but no hypoxia. Patients were randomized 1:1:1 to receive 10 days of RDV, 5 days of RDV, or standard care (SC). The primary endpoint was clinical status on a 7-point ordinal scale, ranging from 1 (death) to 7 (discharged), at day 11.


Results were as follows:


  • 76% of the patients in the 5-day RDV group completed therapy, and 38% of patients in the 10-day RDV group completed therapy; the most common reason for discontinuation was discharge from the hospital.

  • Patients in the 5-day RDV group had a significantly better distribution of clinical status scores than those in the SC group (odds ratio, 1.65); patients in the 10-day RDV group had nonsignificantly better distribution of scores than those in the SC group.

  • There were no significant differences between groups in the exploratory endpoints of time to recovery, time to improvement in clinical status, or death at 28 days.

  • Patients in the 10-day RDV group were significantly more likely to have adverse events than those in the SC group.


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