Remdesivir in COVID-19 Patients (Nov 20, 2020)

CLINICAL CONTEXT: Coronavirus Disease 2019 (COVID19, for its acronym in English Coronavirus Disease 2019) is a respiratory disease of humans caused by a new coronavirus identified with the acronym SARS-CoV-2. On March 11, 2020, the World Health Organization (WHO) declared COVID-19 a pandemic. From that moment until this April 1, its circulation has been reported in 205 countries, reporting more than 800,000 cases and the death of 40,000 people. TECHNOLOGY: Remdesivir (GS-5734) is an adenosine analog prodrug that preferentially competes for viral ATP and is incorporated as a false nucleoside into the new viral RNA strand. Being incorporated into viral RNA strands during their replication results in premature termination of the same. The recommended starting dose is 200 mg given intravenously on the first day, followed by 100 mg once a day for 9 days. OBJECTIVE: The objective of this report is to evaluate the available evidence about the efficacy, safety and aspects related to the coverage policies of the use of remdesivir for the treatment of COVID19. METHODS: A search was carried out in the main bibliographic databases, in generic internet search engines, and health funders. The inclusion of systematic reviews (SR), randomized controlled clinical trials (RCTs), health technology assessments (HTA), economic evaluations, clinical practice guidelines (CPG) and coverage policies of different health systems was prioritized. RESULTS: One RCT, one observational study, and nine CPGs on the treatment of patients diagnosed with COVID19 were included. CONCLUSIONS: Low-quality evidence from a prematurely stopped randomized clinical trial suggests that the use of remdesivir would not be associated with a decrease in mortality, or the time to clinical improvement in patients with COVID-19. Multiple randomized clinical trials in patients with moderate or severe conditions are ongoing. Currently, the main clinical practice guidelines and recommendations of the main international societies, government agencies or expert consensus do not mention or recommend it for the treatment of these patients, and its use is restricted to research studies. No cost-effectiveness or budget impact studies were found in Latin America.