Is remdesivir (an antiviral medicine) an effective treatment | Figure 1

%27%3e%3cg%20id=%27Group-14%27%20transform=%27translate(13.000000,%20103.176124)%27%3e%3cg%20id=%27Group-Copy-5%27%20transform=%27translate(0.000000,%20182.676124)%27%3e%3crect%20id=%27Rectangle-8%27%20fill=%27%23E2E0DE%27%20x=%270%27%20y=%270%27%20width=%2736%27%20height=%2736%27%20rx=%2718%27%3e%3c/rect%3e%3cpath%20d=%27M28,27.6503435%20C28,22.127496%2023.5228474,17.6503435%2018,17.6503435%20C12.4771525,17.6503435%208,22.127496%208,27.6503435%20M18,16.3472505%20C20.8165136,16.3472505%2023.099749,14.0640151%2023.099749,11.2475015%20C23.099749,8.43098783%2020.8165136,6.1477524%2018,6.1477524%20C15.1834863,6.1477524%2012.9002509,8.43098783%2012.9002509,11.2475015%20C12.9002509,14.0640151%2015.1834863,16.3472505%2018,16.3472505%20Z%27%20id=%27Combined-Shape%27%20fill=%27%23FFFFFF%27%20fill-rule=%27nonzero%27%3e%3c/path%3e%3c/g%3e%3c/g%3e%3c/g%3e%3c/g%3e%3c/svg%3e)

Deleted account

Some actions are only available when you log in.

Report case

Report this to our moderators

Is remdesivir (an antiviral medicine) an effective treatment for COVID‐19?

You can view up to 4 cases without signing up Sign up for unlimited access

Key messages

• For adults hospitalised with COVID‐19, remdesivir probably has little or no effect on deaths from any cause up to 28 days after treatment compared with placebo (sham treatment) or usual care.

• We are uncertain whether remdesivir improves or worsens patients’ condition, based on whether they needed more or less help with breathing.

• Researchers should agree on key outcomes to be used in COVID‐19 research, and future studies should investigate these areas. This would allow future updates of this review to draw more certain conclusions about the use of remdesivir to treat COVID‐19.

What is remdesivir?

Remdesivir is a medicine that fights viruses. It has been shown to prevent the virus that causes COVID‐19 (SARS‐CoV‐2) from reproducing. Medical regulators have approved remdesivir for emergency use to treat people with COVID‐19.

What did we do?

We searched for studies that investigated remdesivir to treat adults with COVID‐19 compared to placebo or standard care. Patients were hospitalised with COVID‐19 and could be of any gender or ethnicity.

We found 5 studies with 7452 people hospitalised with COVID‐19. Of these, 3886 people were given remdesivir. The average age of patients was 59 years. Studies took place around the world, mainly in high‐ and upper‐middle‐income countries.

Read the full Cochrane Review:

Comment

Sign up to add a comment

More about this case

Resolved

Why you should join Figure 1

Sign up to explore now

Similar cases

\ \ The use of benzodiazepines to treat adults with delirium, excluding patients being cared for in intensive care units (ICU)\ Background: Delirium is a serious complication of many illnesses, which occurs most commonly in young children and older adults. It usually presents as a sudden change in a patient's behaviour or mental state. Another name for it is ‘acute confusional state.’ Patients with delirium may not know where they are, what time it is, or what is happening to them. They may have frightening experiences, such as vivid hallucinations. They may become either restless or lethargic and inactive. Delirium can be very distressing for patients and for those who are caring for them. Studies show that about a third of patients on general medical wards develop delirium. It is a frequent complication after surgery (e.g. it happens in up to 60% of people who have surgery for a hip fracture). The effects of delirium can last for a long time. For older people, it can lead to longer hospital stays and it has been associated with increased risks of death, disability, loss of independence, and later dementia. It adds significantly to healthcare costs.\ Benzodiazepines are medicines that are often used as sedatives. Sometimes, healthcare workers prescribe them to treat delirium when other strategies have not helped. Currently, it is not clear if benzodiazepines are an effective treatment for patients with delirium or whether they can harm them.\ Review question: Patients need more and better treatment options for delirium. We wanted to know if benzodiazepines are a helpful treatment option for delirium in any healthcare setting except ICU (patients in ICU are very sick and they may need different kinds of treatment). To find the best answer, we looked for studies where the investigators compared any benzodiazepine to another medicine, or to a dummy medicine that does not contain any active ingredients (placebo). To make the comparison fair, patients in the studies must all have had the same random chance (like the flip of a coin) to receive the benzodiazepine or the other treatment.\ Search date: We searched the medical literature up to 10 April 2019.\ Study characteristics: We found only two small studies which were suitable to include in our review. In one study, the 58 patients who took part all had advanced cancer. They were treated in a specialist palliative care unit. The study compared lorazepam (a benzodiazepine) to placebo. In the second study, the 30 patients all had AIDS (acquired immune deficiency syndrome). They were treated in general medical wards. This study compared lorazepam to two different drugs that are sometimes used to treat delirium.\ Key results: We did not find any important benefits for patients who took lorazepam instead of the other treatment in these two studies. Patients who took it did not have better outcomes. We do not have any definite evidence that lorazepam was more harmful than the other treatment, but, in the study of patients with AIDS, the researchers stopped treating people with lorazepam after the first six people who took it all had serious side effects. Because there were only two suitable studies and both had small numbers of patients in them, we cannot draw any firm conclusions. Currently, there is no good evidence to tell us whether or not benzodiazepines should be used to treat patients with delirium. Clinicians, patients, and carers should be aware of the lack of evidence. We think there is a need for more research, and particularly for studies that involve older patients in general medical and surgical settings, where most delirium is treated.](https://app.figure1.com/case-detail/0390cc7d-ea27-4b61-9d5c-5801794036ad)

\ \ Key messages\ ‐ We did not find enough, good‐quality evidence to judge whether vitamin D is an effective or safe treatment for adults with COVID‐19.\ ‐ We need more research on this topic. Future research should focus on well‐designed studies with robust methods.\ ‐ We identified 21 studies on this topic that are ongoing. We will update this review when more evidence becomes available.\ We searched for studies that assessed the use of vitamin D as a treatment for adults with confirmed COVID‐19 compared with a placebo (sham treatment) or another treatment. Vitamin D could be given in any form and in any dose.\ We found three studies with 356 participants. One study took place in Brazil, and the other two in Spain. Two studies had participants with severe COVID‐19 and one had participants with mild COVID‐19 or with no symptoms. All the participants tested positive for COVID‐19 with a laboratory test called ‘PCR’, which is currently the most accurate test available.\ The studies gave their participants different doses of vitamin D. They used different timings from each other, from one large dose in one study to several smaller doses over 14 days in another study. Only two studies said that their participants were vitamin D‐deficient. The other study did not say anything about their participants’ vitamin D status.\ We do not know whether vitamin D helps to prevent death from COVID‐19.\ Vitamin D may reduce the need for patients to be put on a ventilator to help them breathe, but the evidence is uncertain.\ We do not know whether vitamin D causes unwanted effects. Only one study (in participants with severe COVID‐19) reported data on unwanted effects in a way that we could use. It found that one participant out of 119 vomited shortly after being given vitamin D.\ None of the studies reported quality of life.\ What are the limitations of the evidence?\ Our confidence in the evidence is very limited because the studies gave different doses of vitamin D at different times from each other, did not all report participants’ vitamin D status, and did not measure and record their results using consistent methods.\ We found little evidence on unwanted effects and none on quality of life.\ \ How up to date is this evidence?\ The evidence is up to date to 11 March 2021.](https://app.figure1.com/case-detail/16eb2d5b-e0a9-4f08-8d55-2756e7aebced)

\ \ COVID‐19 typically affects the lungs and airways, however, in addition to respiratory problems, about 16% of people hospitalised with COVID‐19 experience problems with their blood and blood vessels, leading to blood clots forming in the arteries, veins and lungs. These blood clots can break loose and travel to other parts of the body, where they may cause blockages leading to heart attacks or strokes. Nearly half of all people with severe COVID‐19, in intensive care units, may develop clots in their veins or arteries.\ What are blood thinners?\ Blood thinners are medicines that prevent harmful blood clots from forming. However, they may cause unwanted effects such as bleeding. Some guidelines recommend giving blood thinners when people are first admitted to hospital with COVID‐19, to prevent blood clots from developing, rather than waiting to see if blood clots develop and then treating them with blood thinners.\ What did we want to find out?\ We wanted to know whether giving people hospitalised with COVID‐19 blood thinners as a preventive measure, reduced the number of deaths compared to people who received no treatment or who received a placebo treatment. We also wanted to know whether these people needed less support with breathing, whether they still developed harmful blood clots, whether they experienced bleeding and whether they experienced any other unwanted events (for example, nausea, vomiting, kidney problems and amputations).\ What did we do?\ We searched for studies that assessed blood thinners given to people hospitalised with COVID‐19 to prevent blood clots. Studies could be of any design as long as they compared a blood thinner with another blood thinner, no treatment or a placebo (sham). Studies could take place anywhere in the world and participants could be any age as long as they were in hospital with confirmed COVID‐19 disease.\ Search date: 20 June 2020\ What we found\ We hoped to find randomised controlled trials (RCTs). RCTs allocate participants at random to receive either the treatment under investigation or the comparison treatment (another treatment, no treatment or placebo). RCTs give the best evidence.\ We did not find any RCTs, so we included seven non‐randomised ‘retrospective’ studies that looked back at treatments given to 5929 people. These studies took place in intensive care units, hospital wards and emergency departments in China, Italy, Spain and the USA. They provided evidence on deaths and bleeding but no evidence on respiratory support, blood clotting and other unwanted effects. The studies were very different from each other, so we were not able to pool their results.\ Blood thinners compared with no treatment (6 studies) ‐ One study reported a reduction in mortality and another study reported a reduction in mortality in severely ill people only. Three studies reported no difference in mortality and the remaining study reported no deaths in either group.\ ‐ One study reported major bleeding in 3% of participants who received blood thinners and 1.9% of participants who did not receive blood thinners.\ Treatment dose of blood thinners compared with preventive dose (1 study) All the participants were in the intensive care unit on mechanical ventilators. They may or may not have had blood clots but were given either blood thinners in a dose usually used to treat clots (higher dose), or a dose used to prevent clots (lower dose).\ ‐ This study reported a lower rate of death in people who received the treatment dose (34.2%) compared with the preventive dose (53%).\ ‐ This study reported major bleeding in 31.7% of participants who received the treatment dose compared with 20.5% of those who received the preventive dose.\ Reliability of the evidence\ We do not know whether blood thinners are a useful preventive treatment for people with COVID‐19 because we are very uncertain about the evidence. None of the studies randomised participants and all were retrospective. Also, they reported different results from each other and did not report their methods fully. This means our confidence (certainty) in the evidence is very low.\ What happens next?\ Our searches found 22 ongoing studies, 20 of which are RCTs, with 14,730 people. We plan to add the results of these studies to our review when they are published. We hope that these better quality studies will provide a conclusive answer to our review question.](https://app.figure1.com/case-detail/3a24bb13-f5d2-45b0-8d4a-6e4cf5d7ee7d)

\ \ Key messages\ We found moderate‐ to high‐certainty evidence from 6 studies to conclude that systemic Janus kinase (JAK) inhibitors are an effective treatment for COVID‐19 in hospitalised people, because they resulted in fewer deaths and a lower rate of clinical deterioration. Evaluation of systemic JAK inhibitors is ongoing in 13 studies whilst the results of 9 further studies are awaiting publication.\ We wanted to know whether systemic JAK inhibitors, in addition to usual care, are effective for people with COVID‐19 when compared to usual care with or without a placebo, and whether they cause unwanted effects. We were particularly interested in:\ • number of deaths from any cause up to 60 days after treatment, or longer if reported;\ • whether people got better or worse after treatment, based on their need for breathing support;\ • unwanted effects of the treatment and infections acquired in hospital.\ We searched for studies that reported on people with COVID‐19 who received systemic JAK inhibitors together with usual care, or usual care alone (plus/minus placebo).\ We found 6 suitable studies involving 11,145 people with COVID‐19. All studies compared systemic JAK inhibitors (baricitinib in 4 studies, tofacitinib in 1 study and ruxolitinib in 1 study) to usual care (in addition to placebo), and were performed in hospitalised people. We found no studies performed in outpatients. Most participants needed oxygen supplementation through low‐flow devices (7220 participants), few (463 participants) were mechanically ventilated at the study entry. We also identified 13 ongoing studies and 9 studies that are completed/terminated but not yet published.\ Main results\ Systemic JAK inhibitors plus usual care compared to usual care alone probably lead to fewer deaths from all causes at up to day 28 and lead to fewer deaths from all causes up to day 60 in the studies. It was not possible to identify subgroups of participants (according to severity of illness) who might benefit most. Systemic JAK inhibitors probably make little or no difference in improvement in clinical status. They probably decrease the risk of worsening of clinical status. Systemic JAK inhibitors probably make little or no difference in the rate of unwanted effects, and probably decrease slightly the occurrence of serious unwanted effects. Systemic JAK inhibitors may result in little or no difference in the rate of infections acquired in hospital.](https://app.figure1.com/case-detail/3d2cd6b5-1172-44e9-ac7c-4ff5514fb3af)

Trending now

\ \ A 52-year-old man presented with a 20-minute history of chest pain radiating to the left shoulder and neck, associated with dyspnea and diaphoresis.\ He had a history of hypertension, long-term smoking, and a sedentary lifestyle.\ On physical examination, bibasilar crackles were noted on lung auscultation. An electrocardiogram (ECG) was performed in the primary care setting, and the patient was promptly referred to the emergency department.](https://app.figure1.com/case-detail/ae0fe999-6875-4474-94f0-ad823dbb9b3a)

\ \ A 28-year-old woman presented with a 3-day history of intense pruritus over the lower back. She reported no recent travel or exposure to new environments. She cares for a small kennel with approximately eight dogs rescued from the streets.\ Physical examination revealed multiple small vesicles, some clustered and others scattered, predominantly involving the lumbar region and the left gluteal area.](https://app.figure1.com/case-detail/c271070f-2bc7-4052-9895-635277e1a7d5)

\ \ A 4-month-old male infant presented with skin lesions localized to the chin for the past 3 days. Physical examination revealed multiple small pustules with surrounding inflammatory signs on the chin, along with a few scattered papules on the chest.](https://app.figure1.com/case-detail/48f41642-b9db-4089-b120-a94ee52328de)

\ \ patient in late teens presenting after a collapse, no chest pain, no previous cardiac history, no history of sudden death in family, are there any features in this ekg that would warrant further work-up or is this just a pediatric ekg?](https://app.figure1.com/case-detail/2af390e1-ace8-40ed-ba1c-98fb2d72f4c5)