June 2, 2020

Background: We have covered the two previous RCTs on remdesivir on REBEL EM (RCT #1 and RCT #2). In the first trial by Wang et al [2], there was no statically significant improvement in clinical outcomes, but, there were trends toward shorter duration of illness. In the ACTT-1 preliminary report [3], despite all the methodological issues, there was a 4 day decrease in clinical improvement (although not in patients requiring HFNC/NIV/IMV/ECMO).  Neither trial was perfect, however in the middle of pandemic, a several day decrease in recovery time may be beneficial in reducing hospital crowding if the difference holds true in subsequent studies and if the correct target population is known.  We now have our 3rd RCT on remdesivir [1], just published in the NEJM comparing 5 days vs 10 days of remdesivir in patients with severe COVID-19.

May 31, 2020

I am fortunate to work in a hospital system that is very forward thinking.  We have a phenomenal relationship with our intensivists, and I have been fortunate enough to have several discussions with them about how we are managing COVID-19 in our ICUs.  For full transparency, I don’t work up in the ICU, but had the opportunity to discuss what we are doing in our ICUs with one of our intensivists (ECMO, steroids, Remdesivir, etc...).  We are doing something different in San Antonio that I thought was worth discussing on this podcast that may be a feasible option for some institutions and some patients, but not all. If there is one thing this disease has taught me, that is one size does not fit all.

May 26, 2020

Background: The saga of Remdesivir for treatment of COVID-19 continues. We previously covered two studies of this drug on REBEL EM (Link is HERE & Link is HERE). One trial (≈200pts) showed no difference in the primary outcome of median time to clinical improvement and the second trial was a compassionate release study which gave us no real clinical information due to its design. A third study was mentioned in the first post from the NIAID, but we didn’t really review it, as much as mention it, as no data was made available.  It was a little teaser from the National Institute of Allergy and Infectious Diseases (NIAID). Despite these facts the FDA approved remdesivir for use and we have had no robust data supporting its use except for the tease of the NIAID study.  Part 1 of the NIAID trial was just published in the NEJM as a preliminary report and we will review here on this post: Remdesivir ACTT-1.

April 30, 2020

Background: Currently, there are no approved medications for the treatment of COVID-19, but,  there are many investigational agents that have shown antiviral activity against SARS-CoV-2 in vitro.  Unfortunately in vitro studies do not always extrapolate to clinical care  In vitro studies of remdesivir demonstrate inhibition of  human and animal coronaviruses tested including SARS-CoV-2.  However, the clinical and antiviral efficacy of remdesivir in COVID-19 remains to be established. The title of this post is, "two more trials just published on Remdesivir," but in reality it is 1.5 trials as we don't have the full release of the 2nd trial (see discussion).
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