Major Update 2: Remdesivir for Adults With COVID-19

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LettersAugust 2022Major Update 2: Remdesivir for Adults With COVID-19FREEAnjum S. Kaka, MD and Timothy J. Wilt, MD, MPHAnjum S. Kaka, MDMinneapolis VA Section of Infectious Diseases and University of Minnesota School of Medicine, Minneapolis, MinnesotaSearch for more papers by this author and Timothy J. Wilt, MD, MPHMinneapolis VA Evidence Synthesis Program, Center for Care Delivery and Outcomes Research, and University of Minnesota School of Medicine, Minneapolis, MinnesotaSearch for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/L22-0212 SectionsAboutVisual AbstractPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail IN RESPONSE: We thank Dr. Finsterer for his comments. Although they are helpful, they do not change our conclusions.Dr. Finsterer states that patients with COVID-19 who are hospitalized frequently experience polypharmacy for this condition. He also notes that these patients frequently have multiple comorbid conditions and that the effectiveness and adverse effect profile of remdesivir may strongly depend on interactions with other drugs, particularly those eliminated through the same pathway in the liver and that exert their effects by the same mechanisms. Thus, he questions our reported conclusions about benefits and harms.We agree that patients with COVID-19 who are hospitalized frequently have comorbidities and receive other medications for COVID-19. However, no approved antiviral therapies with a mechanism of action similar to remdesivir were available when the included studies were conducted. In addition, remdesivir has few known drug–drug interactions, and RCTs (and our review) described inclusion and exclusion criteria regarding patient characteristics and use of concomitant medications (1). Furthermore, in RCTs, the distribution of comorbidities and concomitant medications (as well as other potentially confounding variables) should be similar between intervention and control groups. Finally, in our original review, we described in detail U.S. Food and Drug Administration guidance for patients in whom remdesivir should be used with caution or is contraindicated and those who receive medications contraindicated with remdesivir (2).Dr. Finsterer also comments that another limitation not considered in the calculations and evaluations is the adverse effects of remdesivir itself. We reported serious adverse effects and all adverse effects in both the remdesivir and control groups (as provided by RCTs). We also described U.S. Food and Drug Administration guidance on adverse effects, including hepatotoxicity warranting cessation of remdesivir therapy (2). We agree that postmarketing surveillance and “real-world data” are critical to both characterize rarer adverse effects of new drugs that are not detected in RCTs (such as bradycardia with remdesivir) and assess effectiveness in vaccinated patients and those receiving known effective agents. This knowledge can be used to update U.S. Food and Drug Administration information and clinical practice (1).References1. Lexicomp. Wolters Kluwer. 2022. Accessed at https://online.lexi.com on 4 May 2022. Google Scholar2. Wilt TJ, Kaka AS, MacDonald R, et al. Remdesivir for adults with COVID-19. A living systematic review for American College of Physicians practice points. Ann Intern Med. 2021;174:209-20. [PMID: 33017170] doi:10.7326/M20-5752 LinkGoogle Scholar Comments0 CommentsSign In to Submit A Comment Author, Article, and Disclosure InformationAffiliations: Minneapolis VA Section of Infectious Diseases and University of Minnesota School of Medicine, Minneapolis, MinnesotaMinneapolis VA Evidence Synthesis Program, Center for Care Delivery and Outcomes Research, and University of Minnesota School of Medicine, Minneapolis, MinnesotaDisclosures: Disclosures can be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M21-4784. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetailsSee AlsoMajor Update 2: Remdesivir for Adults With COVID-19: A Living Systematic Review and Meta-analysis for the American College of Physicians Practice Points Anjum S. Kaka , Roderick MacDonald , Eric J. Linskens , Lisa Langsetmo , Kathryn Vela , Wei Duan-Porter , and Timothy J. Wilt Major Update 2: Remdesivir for Adults With COVID-19 Josef Finsterer Metrics August 2022Volume 175, Issue 8Page: W81-W82KeywordsCOVID-19Drug therapyInpatientsSystematic reviews ePublished: 16 August 2022 Issue Published: August 2022 Copyright & PermissionsCopyright © 2022 by American College of Physicians. All Rights Reserved.PDF downloadLoading ...