WHO advises against remdesivir use in COVID-19 patients

A WHO Guideline Development Group (GDG) panel of international experts has advised that the antiviral drug remdesivir is not recommended for patients admitted to hospital with COVID-19, regardless of how severely ill they are, because there is currently no evidence that it improves survival or the need for ventilation. The new recommendation is part of a living guideline on clinical care for COVID-19, developed in collaboration with non-profit the Magic Evidence Ecosystem Foundation (MAGIC) and published in The BMJ.

Living guidelines are useful in fast-moving research areas like COVID-19 because they allow researchers to update previously vetted and peer-reviewed evidence summaries as new information becomes available. In the case of remdesivir, the expert panel conducted an evidence review comparing the effects of several drug treatments for COVID-19 — including data from four international randomised trials involving over 7000 patients hospitalised for COVID-19.

Remdesivir received worldwide attention this year as a potentially effective treatment for severe COVID-19 and is increasingly used to treat patients in hospital, but its role in clinical practice has remained uncertain. After thoroughly reviewing the evidence, the expert panel concluded that remdesivir has no meaningful effect on mortality or on other important outcomes for patients, such as the need for mechanical ventilation or time to clinical improvement.

The panel acknowledged that the certainty of evidence is low and said the evidence did not prove that remdesivir has no benefit; rather, there is no evidence based on currently available data that it does improve important patient outcomes. But given the remaining possibility of important harm, as well as the relatively high cost and resource implications associated with remdesivir (it must be given intravenously), they judged this to be an appropriate recommendation. They also support continued enrolment into trials evaluating remdesivir, especially to provide higher certainty of evidence for specific groups of patients.

Image credit: ©stock.adobe.com/au/Tobias Arhelger

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