Remdesivir for severe covid-19: a clinical practice guideline
Bram Rochwerg, Arnav Agarwal, Linan Zeng, Yee‐Sin Leo, John Adabie Appiah, Thomas Agoritsas, Jessica J Bartoszko, Romina Brignardello‐Petersen, Begüm Ergan, Long Ge, Heike Geduld, Hayley B. Gershengorn, Hela Manai, Minhua Huang, François Lamontagne, Seema Kanda, Letícia Kawano-Dourado, Linda M. Kurian, Arthur Kwizera, Srinivas Murthy, Nida Qadir, Reed Siemieniuk, Maria Asuncion A. Silvestre, Per Olav Vandvik, Zhikang Ye, Dena Zeraatkar, Gordon Guyatt
Abstract
CLINICAL QUESTION: on 22 May 2020. CURRENT PRACTICE: Remdesivir has received worldwide attention as a potentially effective treatment for severe covid-19. After rapid market approval in the US, remdesivir is already being used in clinical practice. RECOMMENDATIONS: The guideline panel makes a weak recommendation for the use of remdesivir in severe covid-19 while recommending continuation of active enrolment of patients into ongoing randomised controlled trials examining remdesivir. HOW THIS GUIDELINE WAS CREATED: An international panel of patients, clinicians, and methodologists produced these recommendations in adherence with standards for trustworthy guidelines using the GRADE approach. The recommendations are based on a linked systematic review and network meta-analysis. The panel considered an individual patient perspective and allowed contextual factors (such as resources) to be taken into account for countries and healthcare systems. THE EVIDENCE: The linked systematic review (published 31 Jul 2020) identified two randomised trials with 1300 participants, showing low certainty evidence that remdesivir may be effective in reducing time to clinical improvement and may decrease mortality in patients with severe covid-19. Remdesivir probably has no important effect on need for invasive mechanical ventilation. Remdesivir may have little or no effect on hospital length of stay. UNDERSTANDING THE RECOMMENDATION: Most patients with severe covid-19 would likely choose treatment with remdesivir given the potential reduction in time to clinical improvement. However, given the low certainty evidence for critical outcomes and the fact that different perspectives, values, and preferences may alter decisions regarding remdesivir, the panel issued a weak recommendation with strong support for continued recruitment in randomised trials.