Remdesivir slightly lowers death, ventilation in COVID hospital patients

COVID-19 patients already on ventilators don't benefit from remdesivir, but the antiviral drug offers a slight reduction in death or progression to ventilation among other hospitalized patients, according to final results from the adaptive World Health Organization's (WHO's) Solidarity randomized trial and an updated meta-analysis.The findings, published this week in The Lancet, were from an ongoing study of four repurposed antiviral drugs as treatments for COVID-19 in hospitalized patients.

The researchers had previously stopped studying the drugs lopinavir, hydroxychloroquine, and interferon β1a because they showed no benefits.

Enrollment in the remdesivir arm, however, continued until donated supplies ran low.The trial enrolled 14,221 patients from 454 hospitals in 35 countries in six WHO regions, including 8,275 randomly assigned to receive either up to 10 daily infusions of remdesivir or an open-label control drug from Mar 22, 2020, to Jan 29, 2021, before the emergence of the Delta and Omicron variants.No benefit for patients already on ventilatorsA total of 602 of 4,146 (14.5%) patients assigned to remdesivir died, compared with 643 of 4,129 (15.6%) control patients (mortality rate ratio [RR], 0.91; 95% confidence interval [CI], 0.82 to 1.02).Among the 359 patients already on a ventilator, 151 (42.1%) assigned to remdesivir died, compared with 134 of 347 (38.6%) control patients (RR, 1.13; 95% CI, 0.89 to 1.42).Of patients not on a ventilator but receiving high- or low-flow oxygen, 14.6% of remdesivir recipients and 16.3% of controls died (RR, 0.87; 95% CI, 0.76 to 0.99).

Among the 1,730 patients who didn't need oxygen at hospital admission, 2.9% of remdesivir participants and 3.8% of controls died (RR, 0.76; 95%