What is the role of remdesivir in the treatment of COVID-19?

Updated: Jan 12, 2021
  • Author: Setu K Patolia, MD, MPH; Chief Editor: Zab Mosenifar, MD, FACP, FCCP  more...
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Remdesivir, a nucleotide analog, has shown efficacy against SARS-CoV-2 in vitro. [28] In the randomized controlled Adaptive COVID-19 Treatment Trial-1 (ACTT-1), remdesivir was superior in reducing median recovery time to 10 days as compared with 15 days in the placebo arm. [36] In another randomized controlled trial, for patients not requiring mechanical ventilation, there was no statistically significant difference between 5 days and 10 days of remdesivir use. [37] However, in another randomized controlled trial, remdesivir was not associated with any improvement in mortality, initiation of mechanical ventilation, and duration of the hospital stay. [31] The US Food and Drug Administration (FDA) has approved remdesivir for the treatment for hospitalized COVID-19 patients aged 12 years and older and weighing at least 40 kg (88 lbs). Remdesivir is given by intravenous infusion. Adverse effects include nausea, vomiting, and transaminitis. An IDSA panel suggests remdesivir for hospitalized patients with severe COVID-19 pneumonia. [35] For patients not on mechanical ventilation or ECMO, IDSA guidelines suggest remdesivir use for only 5 days. [35] For patients without the need of oxygen and an oxygen saturation of greater 94% on room air, the IDSA panel suggests against the use of remdesivir. [35]

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