Update Alert 2: Should Remdesivir Be Used for the Treatment of Patients With COVID-19? Rapid, Living Practice Points From the American College of Physicians (Version 2).

Abstract

LettersDecember 2021Update Alert 2: Should Remdesivir Be Used for the Treatment of Patients With COVID-19? Rapid, Living Practice Points From the American College of Physicians (Version 2)FREEAmir Qaseem, MD, PhD, MHA, Jennifer Yost, PhD, RN, Itziar Etxeandia-Ikobaltzeta, PharmD, PhD, George M. Abraham, MD, MPH, Janet A. Jokela, MD, MPH, Matthew C. Miller, MD, Mary Ann Forciea, MD and Linda L. Humphrey, MD, MPH, for the Scientific Medical Policy Committee of the American College of Physicians*Amir Qaseem, MD, PhD, MHAAmerican College of Physicians, Philadelphia, PennsylvaniaSearch for more papers by this author, Jennifer Yost, PhD, RNVillanova University, Villanova, PennsylvaniaSearch for more papers by this author, Itziar Etxeandia-Ikobaltzeta, PharmD, PhDAmerican College of Physicians, Philadelphia, PennsylvaniaSearch for more papers by this author, George M. Abraham, MD, MPHSaint Vincent Hospital-Worcester Medical Center, Worcester, MassachusettsSearch for more papers by this author, Janet A. Jokela, MD, MPHUniversity of Illinois College of Medicine at Urbana-Champaign, Champaign, IllinoisSearch for more papers by this author, Matthew C. Miller, MDPenn Medicine Radnor, Radnor, PennsylvaniaSearch for more papers by this author, Mary Ann Forciea, MDPenn Medicine, Philadelphia, PennsylvaniaSearch for more papers by this author and Linda L. Humphrey, MD, MPHPortland Veterans Affairs Medical Center and Oregon Health & Science University, Portland, OregonSearch for more papers by this author, for the Scientific Medical Policy Committee of the American College of Physicians*Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/L21-0607 SectionsSupplemental MaterialAboutVisual AbstractPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail This is an update of the American College of Physicians' living, rapid practice points on using remdesivir for treatment of COVID-19 (1, 2), which is based on an updated systematic review that included studies published through 9 August 2021 (3–6). The living, rapid systematic review identified 1 new publication that met inclusion criteria and is relevant to the key questions and Practice Points 1 and 2 (7). This study compared a 10-day course of remdesivir with standard care in adults hospitalized with COVID-19 (7). However, this publication is a subanalysis of a primary study (8) that was already included in the evaluation of evidence in the last major update of the practice points (9). In addition, this subanalysis was not sufficiently powered to address the effect of remdesivir on clinical outcomes of interest. Hence, there was no effect on our prior conclusions (1). The Supplement summarizes the evidence, evidence gaps, and clinical considerations.Practice PointsThe effectiveness and harms of remdesivir in patients with COVID-19 are areas of active research. The following practice points are based on best available evidence as of 9 August 2021. The target patient population includes all hospitalized, nonpregnant, adult patients with COVID-19.Practice Point 1: Consider remdesivir for 5 days to treat hospitalized patients with COVID-19 who do not require invasive ventilation or extracorporeal membrane oxygenation (ECMO).Practice Point 2: Consider extending the use of remdesivir to 10 days to treat hospitalized patients with COVID-19 who require invasive ventilation or ECMO within a 5-day course.Practice Point 3: Avoid initiating remdesivir to treat hospitalized patients with COVID-19 who are already on invasive ventilation or ECMO.