Remdesivir for COVID-19: real-time analysis of all 20 studies

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3/20	Late	Mahajan et al., Indian Journal of Anasthesia, doi:10.4103/ija.IJA_149_21 (Peer Reviewed)	death, ↑76.5%, p=0.47	Clinical outcomes of using remdesivir in patients with moderate to severe COVID-19: A prospective randomised study
	Small RCT with 34 remdesivir patients and 36 controls finding no significant difference in clinical outcomes.
3/20	Details Source PDF Late treatment study Late treatment study
	Mahajan et al., Indian Journal of Anasthesia, doi:10.4103/ija.IJA_149_21 (Peer Reviewed)
	Clinical outcomes of using remdesivir in patients with moderate to severe COVID-19: A prospective randomised study
	Small RCT with 34 remdesivir patients and 36 controls finding no significant difference in clinical outcomes. risk of death, 76.5% higher, RR 1.76, p = 0.47, treatment 5 of 34 (14.7%), control 3 of 36 (8.3%). risk of mechanical ventilation, 111.8% higher, RR 2.12, p = 0.42, treatment 4 of 34 (11.8%), control 2 of 36 (5.6%).
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3/10	Late	Tsuzuki et al., medRxiv, doi:10.1101/2021.03.09.21253183 (Preprint)	death, ↓8.8%, p=1.00	Efficacy of remdesivir in Japanese patients hospitalised with COVID-19: A large observational study using the COVID-19 Registry Japan
	Retrospective database analysis of 1907 hospitalized patients in Japan, using PSM to compare 74 remdesivir patients and 195 control patients, not showing significant differences in mortality and ventilation/ECMO, and showing signifcantly ..
3/10	Details Source PDF Late treatment study Late treatment study
	Tsuzuki et al., medRxiv, doi:10.1101/2021.03.09.21253183 (Preprint)
	Efficacy of remdesivir in Japanese patients hospitalised with COVID-19: A large observational study using the COVID-19 Registry Japan
	Retrospective database analysis of 1907 hospitalized patients in Japan, using PSM to compare 74 remdesivir patients and 195 control patients, not showing significant differences in mortality and ventilation/ECMO, and showing signifcantly longer hospital stay with treatment. PSM did not fully match the patients, for example 65% of matched remdesivir patients were over 65, while only 55% of matched control patients were. risk of death, 8.8% lower, RR 0.91, p = 1.00, treatment 9 of 74 (12.2%), control 26 of 195 (13.3%). risk of mechanical ventilation or ECMO, 17.1% higher, RR 1.17, p = 0.76, treatment 4 of 74 (5.4%), control 9 of 195 (4.6%). hospitalization time, 27.3% higher, relative time 1.27, p < 0.001, treatment 74, control 195.
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3/9	Late	Goldberg et al., Clinical Microbiology and Infection, doi:10.1016/j.cmi.2021.02.029 (Peer Reviewed)	hosp. time, ↓9.2%, p=0.77	A real-life setting evaluation of the effect of remdesivir on viral load in COVID-19 patients admitted to a large tertiary center in Israel
	Retrospective 29 remdesivir patients and 113 controls, not finding a significant difference in nasopharyngeal viral load or hospitalization time. Hospitalization time was lower with treatment, with a larger reduction for non-intubated pat..
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	Goldberg et al., Clinical Microbiology and Infection, doi:10.1016/j.cmi.2021.02.029 (Peer Reviewed)
	A real-life setting evaluation of the effect of remdesivir on viral load in COVID-19 patients admitted to a large tertiary center in Israel
	Retrospective 29 remdesivir patients and 113 controls, not finding a significant difference in nasopharyngeal viral load or hospitalization time. Hospitalization time was lower with treatment, with a larger reduction for non-intubated patients, although not statistically significant in both cases. hospitalization time, 9.2% lower, relative time 0.91, p = 0.77, treatment 29, control 113. hospitalization time, 21.8% lower, relative time 0.78, p = 0.30, non-intubated patients only. risk of no virological cure, 0.1% lower, RR 1.00, p = 0.98, treatment 29, control 113, relative change in Ct values.
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3/8	Late	Fateh et al., medRxiv, doi:10.1101/2021.03.05.21251351 (Preprint)		A single-center retrospective cohort study of Covid-19 medications: Remdesivir, Favipiravir, Methylprednisolone, Dexamethasone, and Interferon β1a and their combinations
	Retrospective 324 hospitalized patients in Iran reporting on the use Remdesivir, Favipiravir, Methylprednisolone, Dexamethasone, and Interferon β1a and their combinations. There is no control group in this study, however authors suggest t..
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	Fateh et al., medRxiv, doi:10.1101/2021.03.05.21251351 (Preprint)
	A single-center retrospective cohort study of Covid-19 medications: Remdesivir, Favipiravir, Methylprednisolone, Dexamethasone, and Interferon β1a and their combinations
	Retrospective 324 hospitalized patients in Iran reporting on the use Remdesivir, Favipiravir, Methylprednisolone, Dexamethasone, and Interferon β1a and their combinations. There is no control group in this study, however authors suggest that Interferon β1a, corticosteroids, and remdesivir may not have a significant effect on mortality of hospitalization time.
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2/27	Safety	Touafchia et al., Clinical Microbiology and Infection, doi:10.1016/j.cmi.2021.02.013 (Peer Reviewed)	safety analysis	Serious bradycardia and remdesivir for coronavirus 2019 (COVID-19): a new safety concerns
	Comparison of bradycardia in COVID-19 patients treated with remdesivir compared to those treated with HCQ, lopinavir/ritonavir, tocilizumab or glucocorticoids, finding increased risk of bradycardia with remdesivir.
2/27	Details Source PDF Safety Safety
	Touafchia et al., Clinical Microbiology and Infection, doi:10.1016/j.cmi.2021.02.013 (Peer Reviewed)
	Serious bradycardia and remdesivir for coronavirus 2019 (COVID-19): a new safety concerns
	Comparison of bradycardia in COVID-19 patients treated with remdesivir compared to those treated with HCQ, lopinavir/ritonavir, tocilizumab or glucocorticoids, finding increased risk of bradycardia with remdesivir.
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12/28	N/A	Shen et al., Fundamentals of Clinical Pharmacology, doi:10.1111/fcp.12643 (Peer Reviewed)	safety analysis	Remdesivir potently inhibits carboxylesterase‐2 through covalent modifications: signifying strong drug‐drug interactions
	Analysis finding that remdesivir at nanomolar concentrations inhibits carboxylesterase‐2 (CES2) through covalent modifications. CES2 is a major drug‐metabolizing enzyme. Authors conclude that caution must be exercised when remdesivir is u..
12/28	Details Source PDF N/A N/A
	Shen et al., Fundamentals of Clinical Pharmacology, doi:10.1111/fcp.12643 (Peer Reviewed)
	Remdesivir potently inhibits carboxylesterase‐2 through covalent modifications: signifying strong drug‐drug interactions
	Analysis finding that remdesivir at nanomolar concentrations inhibits carboxylesterase‐2 (CES2) through covalent modifications. CES2 is a major drug‐metabolizing enzyme. Authors conclude that caution must be exercised when remdesivir is used along with drugs hydrolyzed by CES2.
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12/24	In Vitro	Jeffreys et al., bioRxiv, doi:10.1101/2020.12.23.424232 (Preprint) (In Vitro)	in vitro	Remdesivir-Ivermectin combination displays synergistic interaction with improved in vitro antiviral activity against SARS-CoV-2
	In Vitro study showing enhanced antiviral activity of ivermectin and remdesivir in combination.
12/24	Details Source PDF In Vitro In Vitro
	Jeffreys et al., bioRxiv, doi:10.1101/2020.12.23.424232 (Preprint) (In Vitro)
	Remdesivir-Ivermectin combination displays synergistic interaction with improved in vitro antiviral activity against SARS-CoV-2
	In Vitro study showing enhanced antiviral activity of ivermectin and remdesivir in combination.
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11/29	Late	Ullah et al., International Journal of Sciences, doi:10.18483/ijSci.2417 (Peer Reviewed)	death, ↑100%, p=0.33	Efficacy of Remdesivir in Covid-19 Patients; Multicenter Study in Lahore
	Small late stage (hospitalized, <12 days symptoms) remdesivir study showing non-statistically significant higher mortality with treatment. No adjustments were made for differences in the groups. Remdesivir mean age was 49 vs. control 57...
11/29	Details Source PDF Late treatment study Late treatment study
	Ullah et al., International Journal of Sciences, doi:10.18483/ijSci.2417 (Peer Reviewed)
	Efficacy of Remdesivir in Covid-19 Patients; Multicenter Study in Lahore
	Small late stage (hospitalized, <12 days symptoms) remdesivir study showing non-statistically significant higher mortality with treatment. No adjustments were made for differences in the groups. Remdesivir mean age was 49 vs. control 57. Baseline oxygen requirement was 13.4 liters treatment vs. 10.8 control. Potential confounding by indication. risk of death, 100% higher, RR 2.00, p = 0.33, treatment 8 of 30 (26.7%), control 4 of 30 (13.3%). risk of mechanical ventilation, 250.0% higher, RR 3.50, p = 0.15, treatment 7 of 30 (23.3%), control 2 of 30 (6.7%).
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11/20	Late	Garibaldi et al., medRxiv, doi:10.1101/2020.11.19.20234153 (Preprint)	death, ↓20.0%, p=0.44	Effectiveness of remdesivir with and without dexamethasone in hospitalized patients with COVID-19
	Retrospective 303 remdesivir patients and 303 matched controls showing significantly faster clinical improvement, and lower (but not statistically significant) mortality.
11/20	Details Source PDF Late treatment study Late treatment study
	Garibaldi et al., medRxiv, doi:10.1101/2020.11.19.20234153 (Preprint)
	Effectiveness of remdesivir with and without dexamethasone in hospitalized patients with COVID-19
	Retrospective 303 remdesivir patients and 303 matched controls showing significantly faster clinical improvement, and lower (but not statistically significant) mortality. risk of death, 20.0% lower, RR 0.80, p = 0.44, treatment 23 of 303 (7.6%), control 45 of 303 (14.9%), adjusted. risk of no improvement at day 28, 35.0% lower, RR 0.65, p < 0.001, treatment 52 of 303 (17.2%), control 80 of 303 (26.4%), adjusted.
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11/3	Late	Flisiak et al., medRxiv, doi:10.1101/2020.10.30.20215301 (Preprint)	death, ↓48.9%, p=0.18	Remdesivir-based therapy improved recovery of patients with COVID-19 in the SARSTer multicentre, real-world study
	Retrospective study comparing 122 remdesivir patients and 211 lopinavir/ritonavir patients, showing higher rates of clinical improvement with remdesivir and lower mortality (not statistically significant).
11/3	Details Source PDF Late treatment study Late treatment study
	Flisiak et al., medRxiv, doi:10.1101/2020.10.30.20215301 (Preprint)
	Remdesivir-based therapy improved recovery of patients with COVID-19 in the SARSTer multicentre, real-world study
	Retrospective study comparing 122 remdesivir patients and 211 lopinavir/ritonavir patients, showing higher rates of clinical improvement with remdesivir and lower mortality (not statistically significant). all patients, 48.9% lower, RR 0.51, p = 0.18, treatment 5 of 122 (4.1%), control 17 of 211 (8.1%), OR converted to RR. SpO2<95%, 58.0% lower, RR 0.42, p = 0.13, treatment 4 of 82 (4.9%), control 14 of 119 (11.8%), OR converted to RR. no clinical improvement, 56.5% lower, RR 0.44, p = 0.01, treatment 9 of 122 (7.4%), control 36 of 211 (17.1%), OR converted to RR.
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10/20	Late	Solh et al., medRxiv, doi:10.1101/2020.10.16.20214130 (Preprint)	death, ↓47.0%, p<0.001	Clinical course and outcome of COVID-19 acute respiratory distress syndrome: data from a national repository
	Retrospective database analysis of 7,816 Veterans Affairs hospitalized patients showing 47% reduction in progression from ARDS to mortality.
10/20	Details Source PDF Late treatment study Late treatment study
	Solh et al., medRxiv, doi:10.1101/2020.10.16.20214130 (Preprint)
	Clinical course and outcome of COVID-19 acute respiratory distress syndrome: data from a national repository
	Retrospective database analysis of 7,816 Veterans Affairs hospitalized patients showing 47% reduction in progression from ARDS to mortality. risk of death, 47.0% lower, RR 0.53, p < 0.001, treatment 63 of 219 (28.8%), control 202 of 424 (47.6%), adjusted.
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10/15	Late	SOLIDARITY Trial Consortium, NEJM, doi:10.1056/NEJMoa2023184 (preprint 10/15) (Peer Reviewed)	death, ↓5.0%, p=0.53	Repurposed antiviral drugs for COVID-19; interim WHO SOLIDARITY trial results
	WHO SOLIDARITY open-label RCT with 2,750 very late stage (76% on oxygen/ventilation) Remdesivir patients, mortality relative risk RR 0.95 [0.81-1.11], p=0.50. Non-ventilated patients show a greater benefit, RR 0.86 [0.72-1.04], p = 0.13.
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	SOLIDARITY Trial Consortium, NEJM, doi:10.1056/NEJMoa2023184 (preprint 10/15) (Peer Reviewed)
	Repurposed antiviral drugs for COVID-19; interim WHO SOLIDARITY trial results
	WHO SOLIDARITY open-label RCT with 2,750 very late stage (76% on oxygen/ventilation) Remdesivir patients, mortality relative risk RR 0.95 [0.81-1.11], p=0.50. Non-ventilated patients show a greater benefit, RR 0.86 [0.72-1.04], p = 0.13. risk of death, 5.0% lower, RR 0.95, p = 0.53, treatment 301 of 2743 (11.0%), control 303 of 2708 (11.2%). non-ventilated patients, 14.0% lower, RR 0.86, p = 0.13.
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10/8	Late	Beigel et al., NEJM, doi:10.1056/NEJMoa2007764 (Peer Reviewed)	death, ↓27.0%, p=0.07	Remdesivir for the Treatment of Covid-19 — Final Report
	RCT 1,062 hospitalized patients showing faster recovery time with treatment, median 10 days vs. 15 days for placebo, rate ratio for recovery 1.29, p<0.001. Day 29 mortality was 11.4% with remdesivir and 15.2% with placebo, hazard ratio H..
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	Beigel et al., NEJM, doi:10.1056/NEJMoa2007764 (Peer Reviewed)
	Remdesivir for the Treatment of Covid-19 — Final Report
	RCT 1,062 hospitalized patients showing faster recovery time with treatment, median 10 days vs. 15 days for placebo, rate ratio for recovery 1.29, p<0.001. Day 29 mortality was 11.4% with remdesivir and 15.2% with placebo, hazard ratio HR 0.73 [0.52-1.03]. risk of death, 27.0% lower, RR 0.73, p = 0.07, treatment 541, control 521.
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8/28	Late	Fried et al., Clinical Infectious Disease, doi:10.1093/cid/ciaa1268 (Peer Reviewed)	death, ↓61.2%, p=0.02	Patient Characteristics and Outcomes of 11,721 Patients with COVID19 Hospitalized Across the United States
	Database analysis of 11,721 hospitalized patients, 48 treated with remdesivir. Data inconsistencies have been found in this study, for example 99.4% of patients treated with HCQ were treated in urban hospitals, compared to 65% of untreat..
8/28	Details Source PDF Late treatment study Late treatment study
	Fried et al., Clinical Infectious Disease, doi:10.1093/cid/ciaa1268 (Peer Reviewed)
	Patient Characteristics and Outcomes of 11,721 Patients with COVID19 Hospitalized Across the United States
	Database analysis of 11,721 hospitalized patients, 48 treated with remdesivir. Data inconsistencies have been found in this study, for example 99.4% of patients treated with HCQ were treated in urban hospitals, compared to 65% of untreated patients (Supplemental Table 3), while patients are distributed in a more balanced manner between teaching or not-teaching hospitals, as well as in the most urbanized (Northeast) and less urbanized (Midwest) regions of the United States [1]. [1] academic.oup.com/cid/advance-article/doi/10.1093/cid/ciaa1618/5934822 risk of death, 61.2% lower, RR 0.39, p = 0.02, treatment 4 of 48 (8.3%), control 2510 of 11673 (21.5%), remdesivir vs. non-remdesivir. risk of mechanical ventilation, 36.8% higher, RR 1.37, p = 0.25, treatment 11 of 48 (22.9%), control 1956 of 11673 (16.8%), remdesivir vs. non-remdesivir.
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8/23	Late	Pasquini et al., Journal of Antimicrobial Chemotherapy, doi:10.1093/jac/dkaa321 (Peer Reviewed)	death, ↓16.2%, p<0.0001	Effectiveness of remdesivir in patients with COVID-19 under mechanical ventilation in an Italian ICU
	Retrospective 51 ICU patients under mechanical ventilation, 25 treated with remdesivir, showing lower mortality with treatment.
8/23	Details Source PDF Late treatment study Late treatment study
	Pasquini et al., Journal of Antimicrobial Chemotherapy, doi:10.1093/jac/dkaa321 (Peer Reviewed)
	Effectiveness of remdesivir in patients with COVID-19 under mechanical ventilation in an Italian ICU
	Retrospective 51 ICU patients under mechanical ventilation, 25 treated with remdesivir, showing lower mortality with treatment. risk of death, 16.2% lower, RR 0.84, p < 0.001, treatment 14 of 25 (56.0%), control 24 of 26 (92.3%), adjusted, OR converted to RR, multivariate.
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8/21	Late	Spinner et al., JAMA, doi:10.1001/jama.2020.16349 (Peer Reviewed)	death, ↓34.9%, p=0.50	Effect of Remdesivir vs Standard Care on Clinical Status at 11 Days in Patients With Moderate COVID-19A Randomized Clinical Trial
	Late stage (median 8 days from symptom onset) RCT 584 patients with moderate COVID-19 showing (non-statistically significant) lower mortality. 5-day remdesivir had significantly higher odds of a better clinical status distribution on the..
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	Spinner et al., JAMA, doi:10.1001/jama.2020.16349 (Peer Reviewed)
	Effect of Remdesivir vs Standard Care on Clinical Status at 11 Days in Patients With Moderate COVID-19A Randomized Clinical Trial
	Late stage (median 8 days from symptom onset) RCT 584 patients with moderate COVID-19 showing (non-statistically significant) lower mortality. 5-day remdesivir had significantly higher odds of a better clinical status distribution on the 7-point ordinal scale, odds ratio OR 1.65, p = 0.02. The difference for 10-day remdesivir was not statistically significant, p=0.18. 5 or 10 day remdesivir vs. control 28 day mortality, 34.9% lower, RR 0.65, p = 0.50, treatment 5 of 384 (1.3%), control 4 of 200 (2.0%).
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7/24	Late	Olender et al., Clinical Infectious Diseases, doi:10.1093/cid/ciaa1041 (Peer Reviewed)	death, ↓58.8%, p=0.001	Remdesivir for Severe Coronavirus Disease 2019 (COVID-19) Versus a Cohort Receiving Standard of Care
	Comparative analysis between remdesivir trial GS-US-540–5773 and a retrospective SOC cohort with similar inclusion criteria, showing lower mortality and higher recovery at day 14 with remdesivir.
7/24	Details Source PDF Late treatment study Late treatment study
	Olender et al., Clinical Infectious Diseases, doi:10.1093/cid/ciaa1041 (Peer Reviewed)
	Remdesivir for Severe Coronavirus Disease 2019 (COVID-19) Versus a Cohort Receiving Standard of Care
	Comparative analysis between remdesivir trial GS-US-540–5773 and a retrospective SOC cohort with similar inclusion criteria, showing lower mortality and higher recovery at day 14 with remdesivir. risk of death, 58.8% lower, RR 0.41, p = 0.001, treatment 24 of 312 (7.7%), control 102 of 818 (12.5%), OR converted to RR, day 14, weighted multivariable logistic regression.
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6/30	Late	Dubert et al., International Journal of Infectious Diseases, doi:10.1016/j.ijid.2020.06.093 (Peer Reviewed)		Case report study of the first five COVID-19 patients treated with remdesivir in France
	Early report on 5 ICU patients treated with remdesivir highlighting issues with usage in critically ill patients.
6/30	Details Source PDF Late treatment study Late treatment study
	Dubert et al., International Journal of Infectious Diseases, doi:10.1016/j.ijid.2020.06.093 (Peer Reviewed)
	Case report study of the first five COVID-19 patients treated with remdesivir in France
	Early report on 5 ICU patients treated with remdesivir highlighting issues with usage in critically ill patients.
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6/29	Late	Zhu et al., medRxiv, doi:10.1101/2020.06.22.20136531 (Peer Reviewed) (meta analysis)	death, ↓36.0%, p=0.02	Efficacy and Safety of Remdesivir for COVID-19 Treatment: An Analysis of Randomized, Double-Blind, Placebo-Controlled Trials
	Meta analysis of Beigel and Wang RCTs showing remdesivir significantly decreased mortality (8.18% vs. 12.70%, RR 0.64 [0.44-0.92], p = 0.175).
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	Zhu et al., medRxiv, doi:10.1101/2020.06.22.20136531 (Peer Reviewed) (meta analysis)
	Efficacy and Safety of Remdesivir for COVID-19 Treatment: An Analysis of Randomized, Double-Blind, Placebo-Controlled Trials
	Meta analysis of Beigel and Wang RCTs showing remdesivir significantly decreased mortality (8.18% vs. 12.70%, RR 0.64 [0.44-0.92], p = 0.175). risk of death, 36.0% lower, RR 0.64, p = 0.02.
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5/27	Late	Goldman et al., NEJM, doi:10.1056/NEJMoa2015301 (Peer Reviewed)		Remdesivir for 5 or 10 Days in Patients with Severe Covid-19
	RCT of remdesivir for 5 or 10 days with no placebo control group, showing no significant differences between 5 and 10 day treatment. NCT04292899
5/27	Details Source PDF Late treatment study Late treatment study
	Goldman et al., NEJM, doi:10.1056/NEJMoa2015301 (Peer Reviewed)
	Remdesivir for 5 or 10 Days in Patients with Severe Covid-19
	RCT of remdesivir for 5 or 10 days with no placebo control group, showing no significant differences between 5 and 10 day treatment. NCT04292899
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6/29	Late	Wang et al., Lancet, doi:10.1016/S0140-6736(20)31022-9 (Peer Reviewed)	death, ↑8.6%, p=1.00	Remdesivir in adults with severe COVID-19: a randomised, double-blind, placebo-controlled, multicentre trial
	Small RCT with 237 hospitalized patients in China with severe COVID-19, not showing statistically significant benefits. 158 treatment patients and 79 control patients. While too small for significance, the subgroup treated within 10 days..
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	Wang et al., Lancet, doi:10.1016/S0140-6736(20)31022-9 (Peer Reviewed)
	Remdesivir in adults with severe COVID-19: a randomised, double-blind, placebo-controlled, multicentre trial
	Small RCT with 237 hospitalized patients in China with severe COVID-19, not showing statistically significant benefits. 158 treatment patients and 79 control patients. While too small for significance, the subgroup treated within 10 days showed reduced mortality RR 0.76, p = 0.58, and reduced median time to clinical improvement of 18 days vs. 23 days, hazard ratio 1.52 [0.95-2.43]. all patients, 8.6% higher, RR 1.09, p = 1.00, treatment 22 of 158 (13.9%), control 10 of 78 (12.8%). <10 days from symptoms, 24.3% lower, RR 0.76, p = 0.58, treatment 8 of 71 (11.3%), control 7 of 47 (14.9%). >10 days from symptoms, 47.6% higher, RR 1.48, p = 0.76, treatment 12 of 84 (14.3%), control 3 of 31 (9.7%).
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4/10	Late	Grein et al., NEJM, doi:10.1056/NEJMoa2007016 (Peer Reviewed)		Compassionate Use of Remdesivir for Patients with Severe Covid-19
	Report on compassionate use of remdesivir with 61 severe COVID-19 patients, showing clinical improvement in 36 of 53 patients.
4/10	Details Source PDF Late treatment study Late treatment study
	Grein et al., NEJM, doi:10.1056/NEJMoa2007016 (Peer Reviewed)
	Compassionate Use of Remdesivir for Patients with Severe Covid-19
	Report on compassionate use of remdesivir with 61 severe COVID-19 patients, showing clinical improvement in 36 of 53 patients.
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