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Limited recovery benefits from remdesivir following COVID-19

Remdesivir recovery benefits one year after COVID-19 treatment are similar to standard care according to the findings of a follow-up study

Use of remdesivir for patients hospitalised with COVID-19 does not reduce the risk of continued symptoms after one year any more than standard care according to the findings of a study by Finnish researchers.

Though the majority of patients make a full recovery after infection with COVID-19, a proportion continue to experience what has been defined by the World Health Organisation (WHO) as post-COVID-19 condition. Throughout the pandemic it has become increasingly recognised that after an acute infection, patients continue to experience symptoms or develop new ones. While post-COVID-19 condition is the WHO preferred term, the persistence of symptoms has also been referred to as the short-term and long-term persistent post-acute sequelae of COVID-19 (PASC). Using this definition, a 2021 systematic review that included 57 studies with 250 351 survivors of COVID-19 found that more than half experienced PASC 6 months after recovery.

Treatment of COVID-19 with the anti-viral agent remdesivir in hospitalised patients is effective and reduces mortality for non-ventilated patients with COVID-19 requiring supplemental oxygen therapy. However, given that post-COVID-19 condition occurs in a number of patients, an equally important question is whether treatments such as remdesivir would reduce the risk of developing post-COVID-19 condition? One Italian observational study of 449 hospitalised patients found that use of remdesivir was independently associated with a reduced risk of what the authors referred to as ‘long-COVID syndrome‘. Nevertheless, no other studies have addressed this question and there remains a high level of uncertainty over whether vaccines or in fact, any treatments reduce the risk of post-COVID-19 condition.

In the present study, the Finnish researcher sought to try and answer this question for remdesivir in the SOLIDARITY trial, which was designed to examine the effects of remdesivir plus standard of care (SoC) compared to SoC alone, on post-COVID-19 condition, at one- and two-years post-discharge from hospital. The trial recruited adult patients with a PCR-confirmed diagnosis of COVID-19 and who received remdesivir 200 mg on the first day and then 100 mg daily until discharge or for a maximum of 10 days with SoC or SoC alone. In the follow-up, participants self-completed questionnaires to assess long-term recovery based on continued symptoms and quality-of-life measures.

Remdesivir recovery at 12 months

The SOLIDARITY trial recruited a total of 208 patients with a mean age of 58.3 years (64% male) were recruited and randomised to remdesivir (114) or standard care. After one year, data were available for 181 survivors although at this point in time, 4.4% of the remdesivir group and 5.3% in the standard of care group had died (relative risk, RR = 0.82, 95% CI 0.25 – 2.76).

Self-reported full or largely full, recovery occurred in 85% of those in the remdesivir arm and 86% in the standard of care group (RR = 0.94, 95% CI 0.47 – 1.90). In addition, a similar proportion (15.3% vs 14.5%) of participants reported that they were about halfway recovered to not recovered at all.

Moreover, exertional dyspnoea was experienced by a similar proportion in both groups (RR = 0.61, 95% CI 0.20 – 1.85) and there were similar scores between the two groups for all quality-of-life domain scores.

The authors concluded that there were no discernible effects of remdesivir on long-term recovery, quality of life or long-COVID-19 symptoms. However, they added that since the confidence intervals were wide this included evidence of substantial benefit and harm.

Nevalainen OPO et al. Effect of remdesivir post hospitalization for COVID-19 infection from the randomized SOLIDARITY Finland trial Nat Commun 2022