3D printing of a spike protein from SARS-CoV-2, the virus that causes COVID-19 – before 3D printing a SARS-CoV-2 virus particle. The spike protein (foreground) enables the virus to enter human cells and infect them. On the virus model, the virus surface (blue) is covered with spike proteins (red) that enable the virus to penetrate human cells and infect them. Photo credit: NIH

The antiviral drug remdesivir is not recommended for patients hospitalized with COVID-19, regardless of how seriously ill, as there is currently no evidence that it improves survival or the need for ventilation, according to one WHO Guideline Development Group (GDG). Committee of international experts in the BMJ today.

The recommendation is part of a life guideline developed by the World Health Organization with methodological support from the MAGIC Evidence Ecosystem Foundation to provide trustworthy guidelines for managing COVID-19 and helping doctors make better decisions with their patients.

Life guidelines are useful in fast-paced research areas like COVID-19 as they allow researchers to update previously-reviewed and peer-reviewed evidence summaries as new information becomes available.

Remdesivir has received worldwide attention as a potentially effective treatment for severe COVID-19 and is increasingly used to treat patients in the hospital. However, their role in clinical practice has remained uncertain.

Today’s recommendation is based on a new evidence review comparing the effects of multiple drug treatments for COVID-19. It contains data from four international randomized trials of over 7,000 patients hospitalized for COVID-19.

After carefully reviewing this evidence, the WHO GDG Panel of Experts, made up of experts from around the world, including four patients with COVID-19, concluded that remdesivir did not have a significant impact on mortality or other important outcomes for patients, for example on the need for mechanical ventilation or time to clinical improvement.

The panel acknowledged that the evidence base is low, saying that the evidence does not prove that remdesivir has no benefit. Rather, based on the data currently available, there is no evidence that this improves important patient outcomes.

However, given the remaining possibility of significant harm and the relatively high cost and resource impact of remdesivir (it must be administered intravenously), they judged this to be an appropriate recommendation.

They also support continued inclusion in studies evaluating remdesivir, in particular to ensure greater certainty of evidence for certain patient groups.

In a linked article, US journalist Jeremy Hsu asks what is now for remdesivir as it is unlikely to be the life-saving drug for the masses that many have been hoping for.

The full history of remdesivir won’t be known until manufacturer Gilead publishes full clinical trial reports, writes Hsu, but much will depend on future trials being designed to test remdesivir’s potential effectiveness.

In the meantime, he says, alternative treatments such as the well-known, cheap, and widely used corticosteroid dexamethasone, which has been shown to lower mortality in seriously ill COVID-19 patients, are impacting the discussion about the cost-effectiveness of remdesivir .

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More information:
François Lamontagne et al., A Living WHO Guideline on Medicines against Covid-19, BMJ (2020). DOI: 10.1136 / bmj.m3379 Provided by the British Medical Journal

Quote: WHO guideline development group advises against the use of remdesivir for COVID-19 (2020, November 19) released on November 19, 2020 from https://medicalxpress.com/news/2020-11-guideline-group-remdesivir -covid-.html was obtained

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