Remdesivir In Adults with Severe COVID-19: A Randomised, Double-Blind, Placebo-Controlled, Multicentre Trial

Wang Y, Zhang D, Du G, et al. Lancet. 2020; 395:1569-78. [CrossRef]

No specific antiviral drug has been proven effective for treatment of patients with severe coronavirus disease 2019 (COVID-19). The authors did a randomised, double-blind, placebo-controlled, multicentre trial at ten hospitals in Hubei, China. Eligible patients were adults (aged ≥18 years) admitted to hospital with laboratory-confirmed SARS-CoV-2 infection, with an interval from symptom onset to enrolment of 12 days or less, oxygen saturation of 94% or less on room air or a ratio of arterial oxygen partial pressure to fractional inspired oxygen of 300 mm Hg or less, and radiologically confirmed pneumonia. Patients were randomly assigned in a 2:1 ratio to intravenous remdesivir (200 mg on day 1 followed by 100 mg on days 2–10 in single daily infusions) or the same volume of placebo infusions for 10 days. The primary endpoint was time to clinical improvement up to day 28. Remdesivir use was not associated with a difference in time to clinical improvement (hazard ratio 1·23 [95% CI 0·87–1·75]). Adverse events were reported in 102 (66%) of 155 remdesivir recipients versus 50 (64%) of 78 placebo recipients. Remdesivir was stopped early because of adverse events in 18 (12%) patients versus four (5%) patients who stopped placebo early. The authors conclude that remdesivir was not associated with statistically significant clinical benefits.