Panel Gives Weak Recommendation for Remdesivir for Severe COVID-19 Patients

An international panel has given a “weak recommendation” to use remdesivir in cases where patients have severe coronavirus 2019 (COVID-19).

“We suggest remdesivir rather than noremdesivir in patients with severe COVID-19,” the panel wrote.

The panel’s recommendation was published in a recent paper in The BMJ.

The international panel included COVID-19 patients, intensivists, internists, infectious disease specialists, public health specialists, family physicians, pharmacists, and methodologists.

The panel met to discuss the evidence and formulate a recommendation. No panel member had any relevant financial conflicts of interest; intellectual and professional conflicts were minimized and managed.

The panel did a systematic review of 2 randomized trials that looked at 1300 participants, which “showing low certainty evidence that remdesivir may be effective in reducing time to clinical improvement and may decrease mortality in patients with severe COVID-19,” the panel wrote. “Remdesivir probably has no important effect on need for invasive mechanical ventilation. Remdesivir may have little or no effect on hospital length of stay.”

The World Health Organization (WHO) aided in recruiting panel members to work towards gender balance, and appropriate technical expertise as well as patient representation. The panel was designed to have multidisciplinary and regional representation.

“This contribution reflects a plan from the WHO to use the MAGIC platform and BMJ Rapid Recommendations, among other sources, to inform their own COVID-19 guidance.”

"The Rapid Recommendations team from MAGIC, including The BMJ, will identify and confirm which studies might change practice and are of interest to readers. Researchers will then perform systematic reviews on the benefit and harm of the intervention, baseline risk of important outcomes, and the values and preferences of patients," the panel wrote. "In parallel a panel including researchers, patients, and doctors will choose the most important outcomes. They will consider the systematic reviews and evaluate the evidence using a GRADE approach, and produce recommendations for practice. The research and recommendations will be submitted to The BMJ for peer review and publication."

At the end of May, the New England Journal of Medicine published a study on remdesivir in adult patients with severe coronavirus 2019 (COVID-19), which showed a reduction in time to recovery. This trial was one of the catalysts for the development of the panel.

The panel also made a second recommendation that randomized controlled trials studying remdesivir in COVID-19 patients should continue.

While the panel acknowledged their “weak recommendation” for COVID-19 treatment, “uncertainty regarding any mortality benefit, possible reduction in hospitalisation, and the magnitude of any benefit in time to clinical improvement can only be resolved by continuing enrollment in [randomized controlled trial] RCTs examining remdesivir in comparison with placebo or usual care for patients with severe covid-19,” the panel wrote.

This BMJ Rapid Recommendation represents the first in a series of recommendations for the management of COVID-19.