ACTT-1 – Remdesivir for COVID-19 RCT

Written by Clay Smith

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Remdesivir sped recovery in hospitalized patients with COVID-19 compared to placebo.

Why does this matter?
SIMPLE had no placebo group and seemed to show benefit, though 10 days didn’t seem better than just 5 days of drug (and may have been worse). The preliminary report of ACTT-1 showed remdesivir was likely helpful. SOLIDARITY, by the WHO, did not find benefit, but it was open label, with no placebo groups, and duration of symptoms was not reported. What’s the final report on ACTT-1 show?

COVID treatment – the final ACTT-1
This was a double-blind RCT with 1,062 hospitalized patients with COVID-19 and lower respiratory infection who received remdesivir 200mg loading on day 1 followed by 100mg daily on days 2-10 or placebo. About one fourth of patients were on the ventilator or ECMO. For the primary outcome, the remdesivir group recovered by day 10; placebo by day 15; rate ratio 1.29 (95%CI 1.12 to 1.49). Improvement was most notable in the subgroup requiring oxygen but not yet on the ventilator. As secondary outcomes, 15-day mortality was better with remdesivir, but 29-day mortality was not statistically different. There was no evidence of harm compared to placebo. This study demonstrates that remdesivir is effective, and may be especially so if given early in the illness, before mechanical ventilation is needed. For more, read ID doc and blogger Paul Sax – Does Remdesivir Work? Short answer: “maybe. Sometimes. For some people.”

Source
Remdesivir for the Treatment of Covid-19 – Final Report. N Engl J Med. 2020 Oct 8;NEJMoa2007764. doi: 10.1056/NEJMoa2007764. Online ahead of print.

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