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Rapid, Living Practice Points from ACP: Update on remdesivir use for hospitalized COVID-19 patients

PHILADELPHIA, Feb. 9, 2021 – In updated Rapid, Living Practice Points, the American College of Physicians (ACP) addresses emerging evidence regarding the effectiveness of remdesivir in hospitalized patients with COVID-19 and whether benefits and harms vary by symptom duration, disease severity, and treatment duration. The paper, developed by the Scientific Medical Policy Committee of the ACP, Should Remdesivir Be Used for the Treatment of Patients with COVID-19? Rapid, Living Practice Points from the American College of Physicians (Version 2), was published today in Annals of Internal Medicine.

The ACP’s updated Practice Points aim to target patients who will most benefit from the use of remdesivir and now suggests the following:

  • Consider remdesivir for 5 days to treat hospitalized patients with COVID-19 who do not require mechanical ventilation or extracorporeal membrane oxygenation (ECMO). 
  • Consider extending the use of remdesivir to 10 days to treat hospitalized patients with COVID-19 who require mechanical ventilation or ECMO within a 5-day course.
  • Avoid initiating remdesivir to treat hospitalized patients with COVID-19 who are already on mechanical ventilation or ECMO.

Based on a systematic review conducted by the Minneapolis VA Evidence Synthesis Program that has been updated through Dec. 7, 2020, this version represents a change from the previous classifications of “moderate” and “severe” disease to now describe disease severity according to respiratory support requirements [e.g. no requirement, supplemental oxygen, mechanical ventilation/ECMO].

Remdesivir is a broad-spectrum antiviral agent administered intravenously. It was authorized on Oct. 22, 2020, for emergency use for the treatment of COVID-19 in the U.S. by the Food and Drug Administration and in other countries.

“This update represents current information related to the use of remdesivir,” said Jacqueline W. Fincher, MD, MACP, president, ACP, “and specifically as it relates to its use for patients who are already hospitalized and on mechanical ventilation or ECMO. While limited treatments for COVID-19 currently exist, there are patients in whom remdesivir is beneficial and should be considered.”

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 163,000 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