In a new paper, researchers make a weak recommendation for the use of remdesivir in patients with severe COVID-19, and strongly support continued testing of patients in ongoing clinical trials of remdesivir.
The research was conducted by an international team.
Their advice is part of The BMJ’s Rapid Recommendations initiative—to produce rapid and trustworthy guidelines for clinical practice based on new evidence to help doctors make better decisions with their patients.
The antiviral medication remdesivir has received worldwide attention as a potentially effective treatment for severe COVID-19 and is already being used in clinical practice.
The current recommendation is based on a new evidence review comparing the effects of several drug treatments for COVID-19 up to 20 July 2020.
It shows that remdesivir may be effective in reducing recovery time in patients with severe COVID-19, although the certainty of the evidence is low.
But remdesivir probably has no important effect on the need for mechanical ventilation and may have little or no effect on length of hospital stay.
The authors stress that the effectiveness of most interventions is uncertain because most of the randomised controlled trials so far have been small and have important study limitations.
After thoroughly reviewing this evidence, the team says that most patients with severe COVID-19 would likely choose treatment with remdesivir given the potential reduction in time to clinical improvement.
But given the low certainty evidence, and allowing for different patient perspectives, values, and preferences, they issued a weak recommendation with strong support for continued research.
They suggest that future research should focus on areas such as optimal dose and duration of therapy and whether there are specific groups of patients most likely to benefit from remdesivir.
The authors also sound a note of caution about the potential opportunity cost of using remdesivir while the evidence base is still uncertain.
As a relatively costly drug that is given intravenously, the use of remdesivir may divert funds, time, attention, and workforce away from other potentially worthwhile treatments.
The study is published in The BMJ.
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