Remdesivir Efficacy in COVID-19 Treatment: A Randomized Controlled Trial

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  • 1 Department of Tropical Medicine and Infectious Diseases, Faculty of Medicine, Tanta University, Tanta, Egypt;
  • | 2 Department of Internal Medicine, Faculty of Medicine, Ain Shams University, Cairo, Egypt;
  • | 3 Clinical Pharmacy and Pharmacy Practice Department, Faculty of Pharmacy, Mansoura University, Mansoura, Egypt;
  • | 4 Department of Clinical Pharmacy, The National Hepatology and Tropical Medicine Research Institute, Egypt;
  • | 5 Pharmacy Practice and Clinical Pharmacy Department, Faculty of Pharmacy, Future University in Egypt, Cairo, Egypt;
  • | 6 Public Health and Community Medicine, Menoufia University, Menoufia, Egypt;
  • | 7 Chest Department, Tanta University, Tanta, Egypt;
  • | 8 Department of Tropical Medicine, Faculty of Medicine, Ain Shams University, Cairo, Egypt;
  • | 9 Department of Anesthesia, Surgical Intensive Care and Pain Medicine, Faculty of Medicine, Tanta University, Tanta, Egypt;
  • | 10 Biotechnology Department, Faculty of Biotechnology, Badr University, Cairo, Egypt

To date, no antiviral therapy has shown proven clinical effectiveness in treating patients with COVID-19. We assessed the efficacy of remdesivir in hospitalized Egyptian patients with COVID-19. Patients were randomly assigned at a 1:1 ratio to receive either remdesivir (200 mg on the first day followed by 100 mg daily for the next 9 days intravenously infused over 30–60 minutes) in addition to standard care or standard care alone. The primary outcomes were the length of hospital stay and mortality rate. The need for mechanical ventilation was assessed as a secondary outcome. Two hundred patients (100 in each group) completed the study and were included in the final analysis. The remdesivir group showed a significantly lower median duration of hospital stay (10 days) than the control group (16 days; P < 0.001). Eleven of the patients in the remdesivir group needed mechanical ventilation compared with eight patients in the control group (P = 0.469). The mortality rate was comparable between the two groups (P = 0.602). Mortality was significantly associated with older age, elevated C-reactive protein levels, elevated D-dimer, and the need for mechanical ventilation (P = 0.039, 0.003, 0.001, and < 0.001 respectively). Remdesivir had a positive influence on length of hospital stay, but it had no mortality benefit in Egyptian patients with COVID-19. Its use, in addition to standard care including dexamethasone, should be considered, particularly in low- and middle-income countries when other effective options are scarce.

Author Notes

Address correspondence to Sherief Abd-Elsalam, Department of Tropical Medicine and Infectious Diseases, Faculty of Medicine, Tanta University, El-Giash Street 31527, Tanta, Egypt. E-mail: sherif.abdelbaky@med.tanta.edu.eg

Authors’ addresses: Sherief Abd-Elsalam, Marwa Salama, and Mohammed Elhendawy, Department of Tropical Medicine and Infectious Diseases, Faculty of Medicine, Tanta University, Tanta, Egypt, E-mails: sherif.abdelbaky@med.tanta.edu.eg, marwa.salama@med.tanta.edu.eg, and mohamed.elhendawy@med.tanta.edu.eg. Ossama Ashraf Ahmed, Mohamed Hassan Ahmed Fouad, and Ahmed Mohamed Naguib, Department of Internal Medicine, Faculty of Medicine, Ain Shams University, Cairo, Egypt, E-mails: osamaashraf@yahoo.com, drmohhasaan@gmail.com, and ahmed_naguib@med.asu.edu.eg. Noha O. Mansour, Clinical Pharmacy and Pharmacy Practice Department, Faculty of Pharmacy, Mansoura University, Mansoura, Egypt, E-mail: dr.nohamansour@gmail.com. Doaa H. Abdelaziz, Department of Clinical Pharmacy, The National Hepatology and Tropical Medicine Research Institute, Egypt, and Pharmacy Practice and Clinical Pharmacy Department, Faculty of Pharmacy, Future University in Egypt, Cairo, Egypt, E-mail: doaa.yousef@fue.edu.eg. Shaimaa Soliman, Public Health and Community Medicine, Menoufia University, Menoufia, Egypt, E-mail: shaimaasherif@hotmail.com. Mohamed Sayed Hantera, Ibrahim S. Ibrahim, and Mohamed Torky, Chest Department, Tanta University, Tanta, Egypt, E-mails: mohamed.hantera@med.tanta.edu.eg, ibrahim.s.ibrahim@med.edu.tanta.eg, and mohamed.torky@med.tanta.edu.eg. Hany M. Dabbous, Department of Tropical Medicine, Faculty of Medicine, Ain Shams University, Cairo, Egypt, E-mail: drhdabbous@gmail.com. Mohamed Samir Abd El Ghafar, Department of Anesthesia, Surgical Intensive Care and Pain Medicine, Faculty of Medicine, Tanta University, Tanta, Egypt, E-mail: mohamed.adbelghafar1@med.tanta.edu.eg. Enas A. Abdul-Baki, Biotechnology Department, Faculty of Biotechnology, Badr University, Cairo, Egypt, E-mail: enas.abul-raouf@buc.edu.eg.

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