Posted on 02/24/2023 1:45:36 PM PST by nickcarraway
Remdesivir (Veklury) reduced mortality in non-ventilated patients hospitalized with COVID-19, according to an individual patient data meta-analysis of nine randomized controlled trials (RCTs).
Among patients who received no oxygen or low-flow oxygen, 9.1% of those who were treated with remdesivir died within 28 days of randomization compared with 11.2% of those who did not receive the antiviral (adjusted OR 0.80, 95% CI 0.70-0.93), reported Benjamin Speich, PhD, of University Hospital Basel in Switzerland, and colleagues.
Of the patients on ventilation, including high-flow oxygen, 30% of remdesivir-treated patients died versus 28.5% of those not treated with remdesivir (aOR 1.10, 95% CI 0.88-1.38), they detailed in Lancet Respiratory Medicineopens in a new tab or window and in a poster presentation at this year's Conference on Retroviruses and Opportunistic Infectionsopens in a new tab or window.
"Although subgroup effects in RCTs need to be viewed critically, the consistent direction of effect modification across individual trials, statistical evidence (Pinteraction=0.019 based on individual patient data), and previous evidence for a similar effect modification strengthened the credibility of this subgroup effect," the authors wrote.
Overall, 12.5% of those receiving remdesivir died within 28 days of randomization compared with 14.1% of those not receiving the antiviral (aOR 0.88, 95% CI 0.78-1.00, P=0.045), while at 60 days, the mortality rates were 13.7% versus 15.2%, respectively (P=0.116).
"The National Institutes of Health (NIH), the Infectious Diseases Society of America (IDSA), and WHO generally recommend remdesivir for patients hospitalized with mild to severe COVID-19," Speich and team wrote. "However, the National Institute for Health and Care Excellence (NICE) interprets the evidence differently and uncertainty remains, especially in terms of which subgroup of patients is most likely to benefit."
Of note, patients treated with remdesivir were less likely to need respiratory support, with a better clinical status than their counterparts at both 14 days (aOR 0.88, 95% CI 0.81-0.95, P=0.0015) and 28 days (aOR 0.87, 95% CI 0.80-0.96, P=0.0037).
In an invited commentaryopens in a new tab or window, Andre C. Kalil, MD, MPH, of the University of Nebraska Medical Center in Omaha, criticized the time it took to recommend the treatmentopens in a new tab or window for use in non-ventilated patients hospitalized for COVID.
"Prioritizing underpowered subgroup results instead of powered overall results helped to prevent the NIH and IDSA guidelines from recommending remdesivir to patients hospitalized for COVID-19 without supplemental oxygen for nearly 2 years, and prioritizing the interim results of a high risk of bias trialopens in a new tab or window over the complete and beneficial results of a low risk of bias trialopens in a new tab or window helped to prevent the WHO guidelines from recommending remdesivir to any patients for almost 3 years," Kalil wrote.
"How many more lives could have been saved had remdesivir been recommended more broadly and made more readily available? All of us -- the scientific community, public health agencies, professional societies, journal editors, and guideline committees -- must learn from these mistakes to provide more reliable scientific recommendations to directly benefit the individual care of patients globally, and to advocate for equitable access to safe and life-saving antiviral therapies such as remdesivir in low-income and middle-income countries," he concluded.
For this systematic review and meta-analysis, Speich and colleagues searched PubMed, Embase, the Cochrane COVID-19 trial registry, ClinicalTrials.gov, the International Clinical Trials Registry Platform, and preprint servers from January 2020 to April 11, 2022, for RCTs of remdesivir in adult patients hospitalized with COVID.
They included nine RCTs with a total of 10,480 patients. Median age was 58, 63.1% were men, and 58.1% had at least one comorbidity. Patients were randomly assigned after a median symptom duration of 9 days.
As for safety, 27.3% of patients receiving remdesivir experienced at least one grade 3 or 4 adverse event or serious adverse event within 28 days compared with 32.2% of patients who did not receive remdesivir.
One of the RCTs did not provide individual patient data, which was a limitation cited by Speich and co-authors. In addition, their data did not include patients with SARS-CoV-2 variants that were in widespread circulation only after April 2021, such as Delta, Omicron, and their sublineages, though they noted that remdesivir "maintains efficacy against emerging SARS-CoV-2 variants of concern, and has regained importance in clinical care owing to increasing resistance to current monoclonal antibodies."
author['full_name'] Elizabeth Short is a staff writer for MedPage Today. She often covers pulmonology and allergy & immunology. Follow
Remdesivir is a worthless drug. It looks like its benefit is only in the non critically sick. Not sure it is worth using based on its side effects.
My brother, 69, and my husband’s brother-in-law, 73, both died in January 2022, after being hospitalized for 2 weeks on a ventilator and remdesivir. Fauci should burn in hell for promoting that “treatment.” 🤬
Bttt
A 2% difference? Are they out of their freaking minds? That’s well within any margin of error..
Fauci needs to be tried for crimes against humanity
How can you join the conspiracy theorists? Remdesivir is a pharmaceutical product?
I think they are cherry picking their data....there’s lies, more lies, and then there’s statistics...
Just awful. Very sorry for your loss.
I recently spent close to thirty days in the hospital. If it hadn’t been for the overdoes of blood thinner which almost killed me, I’d have been out in less than a week. I couldn’t move but I begged them to stop the blood thinner as I was peeing out what looked like red latex paint. They kept saying, no this is protocol. Next thing I know, I’ve had five units of whole blood and within ten days I had life threatening DVT’s. My GP looked at the scans of the clots that had blown past the filter in the vein from my legs to the lungs and said, “That was really close. You almost died.”
When the ER doctor got the scan back on that clot he told the nurse, “I’m writing the order now. Give him enough morpheme to keep him comfortable.” He was standing under the sign reading “we do not dispense narcotics.”
My point is hospitals are dangerous because they don’t treat patients as individuals. They treat based on “protocols.” Protocols are statistical.
“Fauci needs to be tried for crimes against humanity”
AGREE!!
Fauci suggested using Remdesivir for Ebola in the 80’s and found out it caused significant liver and kidney damage!
One sick, evil man.
Remdesivir shuts down your kidneys and drowns you in your own fluids.
Seems they were conducting experiments on the patients
Friend suffers from side effects...
Heart issues, breathing issues, memory and eye issues.
The doctor didn’t ask if she wanted it when she was in the hospital with Covid-19.
Remdesivir is a deadly poison.
It was fast-tracked while Ivermectin was blocked.
Remdesivir Needs clinical trial on effect of kidneys
A more useful study would regard the number of patients who did not die after taking Remdesivir following a proper regimen of Ivermectin that failed to stop the virus.
I want to know how many it left highly damages who didn’t die. The drug is toxic and does lots of damage.
I have always given my honest opinion. After I quickly arrived at it hardly helped and possibly hurt critically ill patients. This I didn’t use is more than 6-8 times. Those of us treating this on the early days and delta kept in close touch. I know very few who used this drug after it was introduced.
Hospitals become more dangerous every day.
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