Update Alert 2: Should Remdesivir Be Used for the Treatment of Patients With COVID-19? Rapid, Living Practice Points From the American College of Physicians (Version 2)

Amir Qaseem; Jennifer Yost; Itziar Etxeandia-Ikobaltzeta; George M Abraham; Janet A Jokela; Matthew C Miller; Mary Ann Forciea; Linda L Humphrey; Scientific Medical Policy Committee of the American College of Physicians*; Linda L Humphrey; Rebecca Andrews; Mary Ann Forciea; Ray Haeme; Janet A Jokela; Matthew C Miller; CDR Mark P Tschanz

doi:10.7326/L21-0607

. 2021 Oct 5:L21-0607. doi: 10.7326/L21-0607

Update Alert 2: Should Remdesivir Be Used for the Treatment of Patients With COVID-19? Rapid, Living Practice Points From the American College of Physicians (Version 2)

Amir Qaseem ^1,², Jennifer Yost ^2,², Itziar Etxeandia-Ikobaltzeta ^1,², George M Abraham ^3,², Janet A Jokela ^4,², Matthew C Miller ^5,², Mary Ann Forciea ^6,², Linda L Humphrey ^7,²; Scientific Medical Policy Committee of the American College of Physicians*, Linda L Humphrey ², Rebecca Andrews ², Mary Ann Forciea ², Ray Haeme ², Janet A Jokela ², Matthew C Miller ², CDR Mark P Tschanz ², Scientific Medical Policy Committee of the American College of Physicians*

¹American College of Physicians, Philadelphia, Pennsylvania (A.Q., I.E.)

²Villanova University, Villanova, Pennsylvania (J.Y.)

³Saint Vincent Hospital-Worcester Medical Center, Worcester, Massachusetts (G.M.A.)

⁴University of Illinois College of Medicine at Urbana-Champaign, Champaign, Illinois (J.A.J.)

⁵Penn Medicine Radnor, Radnor, Pennsylvania (M.C.M.)

⁶Penn Medicine, Philadelphia, Pennsylvania (M.A.F.)

⁷Portland Veterans Affairs Medical Center and Oregon Health & Science University, Portland, Oregon (L.L.H.)

* This paper, written by Amir Qaseem, MD, PhD, MHA; Jennifer Yost, PhD, RN; Itziar Etxeandia-Ikobaltzeta, PharmD, PhD; George M. Abraham, MD, MPH; Janet A. Jokela, MD, MPH; Matthew C. Miller, MD; Mary Ann Forciea, MD; and Linda L. Humphrey, MD, MPH, was developed for the Scientific Medical Policy Committee of the American College of Physicians. Individuals who served on the Scientific Medical Policy Committee from initiation of the project until its approval were Linda L. Humphrey, MD, MPH (Chair)†; Adam J. Obley (Vice Chair)‡; Andrew Dunn, MD, MPH‡; Robert M. Centor, MD (Immediate Past Vice Chair)‡; Elie A. Akl, MD, MPH, PhD‡; Rebecca Andrews, MS, MD†; Thomas A. Bledsoe, MD‡; Mary Ann Forciea, MD†; Ray Haeme†§; Janet A. Jokela, MD, MPH†; Devan L. Kansagara, MD, MCR‡; Maura Marcucci, MD, MSc‡; Matthew C. Miller, MD†; and CDR Mark P. Tschanz, DO†.

† Author.

‡ Nonauthor contributor.

§ Nonphysician public representative.

Note: Practice points are meant to guide care based on the best available evidence and may not apply to all patients or individual clinical situations. They should not be used as a replacement for a clinician's judgment. Any reference to a product or process contained in a guideline is not intended as an endorsement of any specific commercial product. All ACP practice points are considered automatically withdrawn or invalid 5 years after publication, or once an update has been issued.

Financial Support: Financial support for the development of the practice points comes exclusively from the ACP operating budget.

²

Disclosures: All financial and intellectual disclosures of interest were declared, and potential conflicts were discussed and managed. Dr. Obley participated in discussion of the practice points but was recused from authorship and voting due to a moderate-level conflict of interest (author of supporting systematic review). Drs. Dunn, Kansagara, and Marcucci participated in the discussion but were recused from authorship and voting due to moderate-level conflicts of interest (authors of recent relevant systematic reviews). A record of disclosures of interest and management of conflicts is kept for each Scientific Medical Policy Committee meeting and conference call and can be viewed at www.acponline.org/about-acp/who-we-are/leadership/boards-committees-councils/scientific-medical-policy-committee/disclosure-of-interests-and-conflict-of-interest-management-summary-for-scientific-medical-policy. Disclosures can also be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=L21-0607.

Corresponding Author: Amir Qaseem, MD, PhD, MHA, American College of Physicians, 190 N. Independence Mall West, Philadelphia, PA 19106; e-mail, aqaseem@acponline.org.

PMCID: PMC8496689 PMID: 34606308

This is an update of the American College of Physicians' living, rapid practice points on using remdesivir for treatment of COVID-19 (1, 2), which is based on an updated systematic review that included studies published through 9 August 2021 (3–6). The living, rapid systematic review identified 1 new publication that met inclusion criteria and is relevant to the key questions and Practice Points 1 and 2 (7). This study compared a 10-day course of remdesivir with standard care in adults hospitalized with COVID-19 (7). However, this publication is a subanalysis of a primary study (8) that was already included in the evaluation of evidence in the last major update of the practice points (9). In addition, this subanalysis was not sufficiently powered to address the effect of remdesivir on clinical outcomes of interest. Hence, there was no effect on our prior conclusions (1). The Supplement summarizes the evidence, evidence gaps, and clinical considerations.

Practice Points

The effectiveness and harms of remdesivir in patients with COVID-19 are areas of active research. The following practice points are based on best available evidence as of 9 August 2021. The target patient population includes all hospitalized, nonpregnant, adult patients with COVID-19.

Practice Point 1: Consider remdesivir for 5 days to treat hospitalized patients with COVID-19 who do not require invasive ventilation or extracorporeal membrane oxygenation (ECMO).

Practice Point 2: Consider extending the use of remdesivir to 10 days to treat hospitalized patients with COVID-19 who require invasive ventilation or ECMO within a 5-day course.

Practice Point 3: Avoid initiating remdesivir to treat hospitalized patients with COVID-19 who are already on invasive ventilation or ECMO.

Supplementary Material

Click here for additional data file.^{(307.1KB, pdf)}

Footnotes

This article was published at Annals.org on 5 October 2021.

Contributor Information

Collaborators: Adam J. Obley, Andrew Dunn, Robert M. Centor, Elie A. Akl, Thomas A. Bledsoe, Devan L. Kansagara, and Maura Marcucci

References

1. Qaseem A , Yost J , Etxeandia-Ikobaltzeta I , et al; Scientific Medical Policy Committee of the American College of Physicians. Should remdesivir be used for the treatment of patients with COVID-19? Rapid, living practice points from the American College of Physicians (version 2). Ann Intern Med. 2021;174:673-679. [PMID: ] doi: 10.7326/M20-8101 [DOI] [PMC free article] [PubMed] [Google Scholar]
2. Qaseem A , Yost J , Etxeandia-Ikobaltzeta I , et al. Update alert: should remdesivir be used for the treatment of patients with COVID-19? Rapid, living practice points from the American College of Physicians (version 2) [Letter]. Ann Intern Med. 2021;174:W66-W67. [PMID: ] doi: 10.7326/L21-0389 [DOI] [PMC free article] [PubMed] [Google Scholar]
3. Kaka AS , MacDonald R , Linskens EJ , et al. Update alert: remdesivir for adults with COVID-19 [Letter]. Ann Intern Med. 2021;174:W65. [PMID: ] doi: 10.7326/L21-0375 [DOI] [PMC free article] [PubMed] [Google Scholar]
4.Wilt TJ, Kaka AS, MacDonald R, et al. Rapid Response: COVID-19: Remdesivir for Hospitalized Adults. Evidence Synthesis Program, Health Services Research and Development Service, Office of Research and Development, Department of Veterans Affairs; 2020. VA ESP Project #09-009.
5. Wilt TJ , Kaka AS , MacDonald R , et al. Remdesivir for adults with COVID-19: a living systematic review for American College of Physicians practice points. Ann Intern Med. 2021;174:209-220. [PMID: ] doi: 10.7326/M20-5752 [DOI] [PMC free article] [PubMed] [Google Scholar]
6.Kaka AS, MacDonald R, Linskens EJ, et al. Update alert 2: remdesivir for adults with COVID-19. Ann Intern Med. 5 October 2021. [Epub ahead of print]. doi:10.7326/L21-0600 [DOI] [PMC free article] [PubMed]
7. Barratt-Due A , Olsen IC , Nezvalova-Henriksen K , et al; NOR-Solidarity trial. Evaluation of the effects of remdesivir and hydroxychloroquine on viral clearance in COVID-19: a randomized trial. Ann Intern Med. 2021;174:1261-1269. [PMID: ] doi: 10.7326/M21-0653 [DOI] [PMC free article] [PubMed] [Google Scholar]
8. Pan H , Peto R , Henao-Restrepo AM , et al; WHO Solidarity Trial Consortium. Repurposed antiviral drugs for Covid-19—interim WHO Solidarity trial results. N Engl J Med. 2021;384:497-511. [PMID: ] doi: 10.1056/NEJMoa2023184 [DOI] [PMC free article] [PubMed] [Google Scholar]
9. Kaka AS , MacDonald R , Greer N , et al. Major update: remdesivir for adults with COVID-19: a living systematic review and meta-analysis for the American College of Physicians practice points. Ann Intern Med. 2021;174:663-672. [PMID: ] doi: 10.7326/M20-8148 [DOI] [PMC free article] [PubMed] [Google Scholar]

Associated Data

This section collects any data citations, data availability statements, or supplementary materials included in this article.

Supplementary Materials

Click here for additional data file.^{(307.1KB, pdf)}

[r1-L210607] 1. Qaseem A , Yost J , Etxeandia-Ikobaltzeta I , et al; Scientific Medical Policy Committee of the American College of Physicians. Should remdesivir be used for the treatment of patients with COVID-19? Rapid, living practice points from the American College of Physicians (version 2). Ann Intern Med. 2021;174:673-679. [PMID: ] doi: 10.7326/M20-8101 [DOI] [PMC free article] [PubMed] [Google Scholar]

[r2-L210607] 2. Qaseem A , Yost J , Etxeandia-Ikobaltzeta I , et al. Update alert: should remdesivir be used for the treatment of patients with COVID-19? Rapid, living practice points from the American College of Physicians (version 2) [Letter]. Ann Intern Med. 2021;174:W66-W67. [PMID: ] doi: 10.7326/L21-0389 [DOI] [PMC free article] [PubMed] [Google Scholar]

[r3-L210607] 3. Kaka AS , MacDonald R , Linskens EJ , et al. Update alert: remdesivir for adults with COVID-19 [Letter]. Ann Intern Med. 2021;174:W65. [PMID: ] doi: 10.7326/L21-0375 [DOI] [PMC free article] [PubMed] [Google Scholar]

[r4-L210607] 4.Wilt TJ, Kaka AS, MacDonald R, et al. Rapid Response: COVID-19: Remdesivir for Hospitalized Adults. Evidence Synthesis Program, Health Services Research and Development Service, Office of Research and Development, Department of Veterans Affairs; 2020. VA ESP Project #09-009.

[r5-L210607] 5. Wilt TJ , Kaka AS , MacDonald R , et al. Remdesivir for adults with COVID-19: a living systematic review for American College of Physicians practice points. Ann Intern Med. 2021;174:209-220. [PMID: ] doi: 10.7326/M20-5752 [DOI] [PMC free article] [PubMed] [Google Scholar]

[r6-L210607] 6.Kaka AS, MacDonald R, Linskens EJ, et al. Update alert 2: remdesivir for adults with COVID-19. Ann Intern Med. 5 October 2021. [Epub ahead of print]. doi:10.7326/L21-0600 [DOI] [PMC free article] [PubMed]

[r7-L210607] 7. Barratt-Due A , Olsen IC , Nezvalova-Henriksen K , et al; NOR-Solidarity trial. Evaluation of the effects of remdesivir and hydroxychloroquine on viral clearance in COVID-19: a randomized trial. Ann Intern Med. 2021;174:1261-1269. [PMID: ] doi: 10.7326/M21-0653 [DOI] [PMC free article] [PubMed] [Google Scholar]

[r8-L210607] 8. Pan H , Peto R , Henao-Restrepo AM , et al; WHO Solidarity Trial Consortium. Repurposed antiviral drugs for Covid-19—interim WHO Solidarity trial results. N Engl J Med. 2021;384:497-511. [PMID: ] doi: 10.1056/NEJMoa2023184 [DOI] [PMC free article] [PubMed] [Google Scholar]

[r9-L210607] 9. Kaka AS , MacDonald R , Greer N , et al. Major update: remdesivir for adults with COVID-19: a living systematic review and meta-analysis for the American College of Physicians practice points. Ann Intern Med. 2021;174:663-672. [PMID: ] doi: 10.7326/M20-8148 [DOI] [PMC free article] [PubMed] [Google Scholar]

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Update Alert 2: Should Remdesivir Be Used for the Treatment of Patients With COVID-19? Rapid, Living Practice Points From the American College of Physicians (Version 2)

Amir Qaseem, MD, PhD, MHA

Jennifer Yost, PhD, RN

Itziar Etxeandia-Ikobaltzeta, PharmD, PhD

George M Abraham, MD, MPH

Janet A Jokela, MD, MPH

Matthew C Miller, MD

Mary Ann Forciea, MD

Linda L Humphrey, MD, MPH

Linda L Humphrey, MD, MPH

Rebecca Andrews, MS, MD

Mary Ann Forciea, MD

Ray Haeme

Janet A Jokela, MD, MPH

Matthew C Miller, MD

CDR Mark P Tschanz, DO

Practice Points

Supplementary Material

Footnotes

Contributor Information

References

Associated Data

Supplementary Materials

ACTIONS

PERMALINK

RESOURCES

Cite

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PERMALINK

Update Alert 2: Should Remdesivir Be Used for the Treatment of Patients With COVID-19? Rapid, Living Practice Points From the American College of Physicians (Version 2)

Amir Qaseem, MD, PhD, MHA

Jennifer Yost, PhD, RN

Itziar Etxeandia-Ikobaltzeta, PharmD, PhD

George M Abraham, MD, MPH

Janet A Jokela, MD, MPH

Matthew C Miller, MD

Mary Ann Forciea, MD

Linda L Humphrey, MD, MPH

Linda L Humphrey, MD, MPH

Rebecca Andrews, MS, MD

Mary Ann Forciea, MD

Ray Haeme

Janet A Jokela, MD, MPH

Matthew C Miller, MD

CDR Mark P Tschanz, DO

Practice Points

Supplementary Material

Footnotes

Contributor Information

References

Associated Data

Supplementary Materials

ACTIONS

PERMALINK

RESOURCES

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