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Disclosures: Qaseem reports no relevant financial disclosures. Please see the paper for all other authors’ relevant financial disclosures.
February 10, 2021
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ACP updates guidance on remdesivir as COVID-19 treatment

Disclosures: Qaseem reports no relevant financial disclosures. Please see the paper for all other authors’ relevant financial disclosures.
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The ACP announced it was asserting its previous Rapid Living Practice Points that 5- and 10-day courses of remdesivir provide “a net benefit” vs. placebo or standard care in hospitalized, nonpregnant adults with COVID-19.

The latest practice points, unlike the inaugural version, use respiratory support requirements (eg, no requirement, supplemental oxygen, mechanical ventilation/extracorporeal membrane oxygenation) instead of characterizing disease as “moderate” or “severe” to indicate COVID-19 severity, according to the organization.

The updated recommendations are: consider 5 days of remdesivir for hospitalized patients with COVID-19 who do not require mechanical ventilation or extracorporeal membrane oxygenation; consider extending remdesivir treatment to 10 days in hospitalized patients with COVID-19 who require mechanical ventilation or extracorporeal membrane oxygenation within a 5-day course; and avoid beginning remdesivir treatment in hospitalized patients with COVID-19 who are already on mechanical ventilation or extracorporeal membrane oxygenation.
Reference: Qaseem A, et al. Ann Intern Med. 2021;doi:10.7326/M20-8101.

The update is based on one new study and a study that was completed in the interval between the first and second versions of the practice points, Amir Qaseem, MD, PhD, MA, and other members of the Scientific Medical Policy Committee (SMPC) of ACP wrote in Annals of Internal Medicine.

The updated recommendations are to:

  • consider 5 days of remdesivir for hospitalized patients with COVID-19 who do not require mechanical ventilation or extracorporeal membrane oxygenation;
  • consider extending remdesivir treatment to 10 days in hospitalized patients with COVID-19 who require mechanical ventilation or extracorporeal membrane oxygenation within a 5-day course; and
  • avoid beginning remdesivir treatment in hospitalized patients with COVID-19 who are already on mechanical ventilation or extracorporeal membrane oxygenation.

“An important area of uncertainty relates to the use of remdesivir in patients who do not require supplemental oxygen at hospitalization, although we expect that most patients with a diagnosis of COVID-19 are admitted with respiratory signs and symptoms,” Qaseem and the committee wrote. “In consideration of limited treatment options for COVID-19, the SMPC considered the evidence as insufficient to advise against considering the use of remdesivir in patients who do not require supplemental oxygen at the time of drug initiation.”

Amir Qaseem

The updated practice points are based on a systematic review conducted by the Minneapolis VA Evidence Synthesis Program that has been updated through Dec. 7, 2020, Qaseem and colleagues wrote. Additional updates are currently planned for every 2 months through December.