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Living Practice Points from ACP: Evidence Shows Benefit of Remdesivir for patients with COVID-19

Philadelphia, PA (Oct. 5, 2020) – In new Rapid Living Practice Points, the American College of Physicians (ACP) says that evidence points toward a net benefit with the use of remdesivir for patients with COVID-19. Should Remdesivir Be Used for the Treatment of Patients with COVID-19? Rapid, Living Practice Points from the American College of Physicians (Version 1) was published today in Annals of Internal Medicine.

The ACP Practice Points provide clinical advice based on the best available evidence on the benefits and harms of the use of remdesivir for COVID-19 patients. The Practice Points are based on a rapid systematic review conducted by the VA Evidence Synthesis Program.

Remdesivir is a broad-spectrum antiviral agent administered intravenously. Currently the effectiveness of remdesivir is being tested as a treatment for patients infected with SARS-CoV-2 (COVID-19) and has been authorized for emergency use for the treatment of COVID-19 in the US by the Food and Drug Administration and in other countries.

The ACP Practice Points found that evidence points toward a net benefit for using remdesivir in patients with COVID-19 and recommend:

  • Use remdesivir for 5 days as a treatment for patients with moderate COVID-19.
  • Use remdesivir for 5 days as a treatment for patients with severe COVID-19 who do not require mechanical ventilation or extracorporeal membrane oxygenation (ECMO). 
  • Consider extending the use of remdesivir to 10 days in patients with severe COVID-19 requiring mechanical ventilation or ECMO within a 5-day course.

ACP’s Living Practice Points show that evidence comparing 5-day vs. 10-day course indicated that a 5-day course of remdesivir may slightly reduce mortality and may slightly increase clinical improvement compared with a 10-day course. Evidence for potential harms showed that a 5-day course may result in slightly fewer adverse events (any) compared with a 10-day course, although the shorter course may not result in fewer serious adverse events.

There is no evidence for any effect on other critical outcomes (recovery, hospital length of stay) or important outcomes (time to recovery, time to clinical improvement, invasive mechanical ventilation/ECMO, non-serious adverse events) with either course in patients with moderate COVID-19. There is no evidence about whether outcomes vary by symptom duration in patients with moderate COVID-19.

 “With remdesivir there is evidence of benefit with shorter duration treatment for patients with both moderate or severe COVID-19,” said Jacqueline W. Fincher, MD, ACP President, “which is positive news in the search for treatments of patients with COVID-19. However, significant evidence gaps remain and additional rigorous studies are needed to assess the benefits and harms of using remdesivir to treat patients with COVID-19.”

While more evidence is needed and several studies are planned, there is evidence that a 5-day course is as effective as a 10-day course of remdesivir with fewer potential harms in patients with severe COVID-19 not requiring mechanical ventilation or ECMO at baseline or a 10 day course in patients with severe COVID-19 who progress to needing mechanical ventilation or ECMO within a 5 day course. ACP’s Practice Points suggest that future studies should assess treatment duration by symptom, severity and evaluate clinical outcomes such as respiratory failure.

ACP’s Practice Points are developed by ACP’s Scientific Medical Policy Committee and provide advice to improve the health of individuals and populations and promote high value care based on the best available evidence derived from assessment of scientific work (e.g. clinical guidelines, systematic reviews, individual studies). ACP Practice Points aim to address the value of screening and diagnostic tests and therapeutic interventions for various diseases, and consider known determinants of health, including but not limited to genetic variability, environment, and lifestyle.

The ACP Practice Points will be maintained as a “living” document and ACP’s Scientific Medical Policy Committee will monitor emerging evidence to determine its impact on the main findings and conclusions, and issue updates as needed.

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About the American College of Physicians
The American College of Physicians is the largest medical specialty organization in the United States with members in more than 145 countries worldwide. ACP membership includes 159,000 internal medicine physicians (internists), related subspecialists, and medical students. Internal medicine physicians are specialists who apply scientific knowledge and clinical expertise to the diagnosis, treatment, and compassionate care of adults across the spectrum from health to complex illness. Follow ACP on Twitter, Facebook and Instagram.

ACP Media Contact: Andrew Hachadorian, (215) 351-2514, AHachadorian@acponline.org